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Abstract
Background and Objectives The objectives of this study were to develop and establish concurrent validity of a clinically relevant definition of poor cognitive outcome 1 year after mild traumatic brain injury (mTBI), to compare baseline characteristics across cognitive outcome groups, and to determine whether poor 1-year cognitive outcome can be predicted by routinely available baseline clinical variables.
Methods Prospective cohort study included 656 participants ≥17 years of age presenting to level 1 trauma centers within 24 hours of mTBI (Glasgow Coma Scale score 13–15) and 156 demographically similar healthy controls enrolled in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Poor 1-year cognitive outcome was defined as cognitive impairment (below the ninth percentile of normative data on ≥2 cognitive tests), cognitive decline (change score [1-year score minus best 2-week or 6-month score] exceeding the 90% reliable change index on ≥2 cognitive tests), or both. Associations of poor 1-year cognitive outcome with 1-year neurobehavioral outcomes were performed to establish concurrent validity. Baseline characteristics were compared across cognitive outcome groups, and backward elimination logistic regression was used to build a prediction model.
Results Mean age of participants with mTBI was 40.2 years; 36.6% were female; 76.6% were White. Poor 1-year cognitive outcome was associated with worse 1-year functional outcome, more neurobehavioral symptoms, greater psychological distress, and lower satisfaction with life (all p < 0.05), establishing concurrent validity. At 1 year, 13.5% of participants with mTBI had a poor cognitive outcome vs 4.5% of controls (p = 0.003). In univariable analyses, poor 1-year cognitive outcome was associated with non-White race, lower education, lower income, lack of health insurance, hyperglycemia, preinjury depression, and greater injury severity (all p < 0.05). The final multivariable prediction model included education, health insurance, preinjury depression, hyperglycemia, and Rotterdam CT score ≥3 and achieved an area under the curve of 0.69 (95% CI 0.62–0.75) for the prediction of a poor 1-year cognitive outcome, with each variable associated with >2-fold increased odds of poor 1-year cognitive outcome.
Discussion Poor 1-year cognitive outcome is common, affecting 13.5% of patients with mTBI vs 4.5% of controls. These results highlight the need for better understanding of mechanisms underlying poor cognitive outcome after mTBI to inform interventions to optimize cognitive recovery.
Glossary
- BSI-18-GSI=
- 18-item Brief Symptom Inventory Global Severity Index;
- CDE=
- Common Data Element;
- ED=
- emergency department;
- GCS=
- Glasgow Coma Scale;
- GOAT=
- Galveston Orientation and Amnesia Test;
- GOSE-TBI=
- Glasgow Outcome Scale Extended TBI Version;
- mTBI=
- mild TBI;
- PSI=
- Processing Speed Index;
- RAVLT=
- Rey Auditory Verbal Learning Test;
- RCI=
- reliable change index;
- TBI=
- traumatic brain injury;
- TMT=
- Trail Making Test;
- TRACK-TBI=
- Transforming Research and Clinical Knowledge in TBI;
- WAIS-IV=
- Wechsler Adult Intelligence Scale–4th Edition
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
TRACK-TBI Investigators are listed in appendix 2 at the end of the article.
Podcast: NPub.org/Podcast9812
- Received July 2, 2021.
- Accepted in final form January 3, 2022.
- © 2022 American Academy of Neurology
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- Author Response: Cognitive Outcome 1 Year After Mild Traumatic Brain Injury
- Reader Response: Cognitive Outcome 1 Year After Mild Traumatic Brain Injury: Results From the TRACK-TBI Study
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