Longitudinal Recovery Following Repetitive Traumatic Brain Injury
Importance: One traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited.
Objective: To investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years.
Design, Setting, and Participants: This cohort study included participants presenting to emergency departments enrolled within 24 hours of TBI in the prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years, February 2014 to July 2020). Participants who completed outcome assessments at 1 year and 3 to 7 years were included. Data were analyzed from September 2022 to August 2023.
Exposures: Postindex TBI(s).
Main Outcomes and Measures: Demographic and clinical factors, prior TBI (ie, preindex TBI), and functional (Glasgow Outcome Scale-Extended [GOSE]), postconcussive (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]), psychological distress (Brief Symptom Inventory-18 [BSI-18]), depressive (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5 [PCL-5]), and health-related quality-of-life (Quality of Life After Brain Injury-Overall Scale [QOLIBRI-OS]) outcomes were assessed. Adjusted mean differences (aMDs) and adjusted relative risks are reported with 95% CIs.
Results: Of 2417 TRACK-TBI participants, 1572 completed the outcomes assessment at 1 year (1049 [66.7%] male; mean [SD] age, 41.6 [17.5] years) and 1084 completed the outcomes assessment at 3 to 7 years (714 [65.9%] male; mean [SD] age, 40.6 [17.0] years). At 1 year, a total of 60 participants (4%) were Asian, 255 (16%) were Black, 1213 (77%) were White, 39 (2%) were another race, and 5 (0.3%) had unknown race. At 3 to 7 years, 39 (4%) were Asian, 149 (14%) were Black, 868 (80%) were White, 26 (2%) had another race, and 2 (0.2%) had unknown race. A total of 50 (3.2%) and 132 (12.2%) reported 1 or more postindex TBIs at 1 year and 3 to 7 years, respectively. Risk factors for postindex TBI were psychiatric history, preindex TBI, and extracranial injury severity. At 1 year, compared with those without postindex TBI, participants with postindex TBI had worse functional recovery (GOSE score of 8: adjusted relative risk, 0.57; 95% CI, 0.34-0.96) and health-related quality of life (QOLIBRI-OS: aMD, -15.9; 95% CI, -22.6 to -9.1), and greater postconcussive symptoms (RPQ: aMD, 8.1; 95% CI, 4.2-11.9), psychological distress symptoms (BSI-18: aMD, 5.3; 95% CI, 2.1-8.6), depression symptoms (PHQ-9: aMD, 3.0; 95% CI, 1.5-4.4), and PTSD symptoms (PCL-5: aMD, 7.8; 95% CI, 3.2-12.4). At 3 to 7 years, these associations remained statistically significant. Multiple (2 or more) postindex TBIs were associated with poorer outcomes across all domains.
Conclusions and Relevance: In this cohort study of patients with acute TBI, postindex TBI was associated with worse symptomatology across outcome domains at 1 year and 3 to 7 years postinjury, and there was a dose-dependent response with multiple postindex TBIs. These results underscore the critical need to provide TBI prevention, education, counseling, and follow-up care to at-risk patients.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:6 |
|---|---|
| Enthalten in: |
JAMA network open - 6(2023), 9 vom: 05. Sept., Seite e2335804 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Etemad, Leila L [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Journal Article |
|---|
| Anmerkungen: |
Date Completed 27.09.2023 Date Revised 22.12.2023 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1001/jamanetworkopen.2023.35804 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM362475504 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM362475504 | ||
| 003 | DE-627 | ||
| 005 | 20231227135902.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1001/jamanetworkopen.2023.35804 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1235.xml |
| 035 | |a (DE-627)NLM362475504 | ||
| 035 | |a (NLM)37751204 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Etemad, Leila L |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Longitudinal Recovery Following Repetitive Traumatic Brain Injury |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 27.09.2023 | ||
| 500 | |a Date Revised 22.12.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Importance: One traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited | ||
| 520 | |a Objective: To investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years | ||
| 520 | |a Design, Setting, and Participants: This cohort study included participants presenting to emergency departments enrolled within 24 hours of TBI in the prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years, February 2014 to July 2020). Participants who completed outcome assessments at 1 year and 3 to 7 years were included. Data were analyzed from September 2022 to August 2023 | ||
| 520 | |a Exposures: Postindex TBI(s) | ||
| 520 | |a Main Outcomes and Measures: Demographic and clinical factors, prior TBI (ie, preindex TBI), and functional (Glasgow Outcome Scale-Extended [GOSE]), postconcussive (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]), psychological distress (Brief Symptom Inventory-18 [BSI-18]), depressive (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5 [PCL-5]), and health-related quality-of-life (Quality of Life After Brain Injury-Overall Scale [QOLIBRI-OS]) outcomes were assessed. Adjusted mean differences (aMDs) and adjusted relative risks are reported with 95% CIs | ||
| 520 | |a Results: Of 2417 TRACK-TBI participants, 1572 completed the outcomes assessment at 1 year (1049 [66.7%] male; mean [SD] age, 41.6 [17.5] years) and 1084 completed the outcomes assessment at 3 to 7 years (714 [65.9%] male; mean [SD] age, 40.6 [17.0] years). At 1 year, a total of 60 participants (4%) were Asian, 255 (16%) were Black, 1213 (77%) were White, 39 (2%) were another race, and 5 (0.3%) had unknown race. At 3 to 7 years, 39 (4%) were Asian, 149 (14%) were Black, 868 (80%) were White, 26 (2%) had another race, and 2 (0.2%) had unknown race. A total of 50 (3.2%) and 132 (12.2%) reported 1 or more postindex TBIs at 1 year and 3 to 7 years, respectively. Risk factors for postindex TBI were psychiatric history, preindex TBI, and extracranial injury severity. At 1 year, compared with those without postindex TBI, participants with postindex TBI had worse functional recovery (GOSE score of 8: adjusted relative risk, 0.57; 95% CI, 0.34-0.96) and health-related quality of life (QOLIBRI-OS: aMD, -15.9; 95% CI, -22.6 to -9.1), and greater postconcussive symptoms (RPQ: aMD, 8.1; 95% CI, 4.2-11.9), psychological distress symptoms (BSI-18: aMD, 5.3; 95% CI, 2.1-8.6), depression symptoms (PHQ-9: aMD, 3.0; 95% CI, 1.5-4.4), and PTSD symptoms (PCL-5: aMD, 7.8; 95% CI, 3.2-12.4). At 3 to 7 years, these associations remained statistically significant. Multiple (2 or more) postindex TBIs were associated with poorer outcomes across all domains | ||
| 520 | |a Conclusions and Relevance: In this cohort study of patients with acute TBI, postindex TBI was associated with worse symptomatology across outcome domains at 1 year and 3 to 7 years postinjury, and there was a dose-dependent response with multiple postindex TBIs. These results underscore the critical need to provide TBI prevention, education, counseling, and follow-up care to at-risk patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Yue, John K |e verfasserin |4 aut | |
| 700 | 1 | |a Barber, Jason |e verfasserin |4 aut | |
| 700 | 1 | |a Nelson, Lindsay D |e verfasserin |4 aut | |
| 700 | 1 | |a Bodien, Yelena G |e verfasserin |4 aut | |
| 700 | 1 | |a Satris, Gabriela G |e verfasserin |4 aut | |
| 700 | 1 | |a Belton, Patrick J |e verfasserin |4 aut | |
| 700 | 1 | |a Madhok, Debbie Y |e verfasserin |4 aut | |
| 700 | 1 | |a Huie, J Russell |e verfasserin |4 aut | |
| 700 | 1 | |a Hamidi, Sabah |e verfasserin |4 aut | |
| 700 | 1 | |a Tracey, Joye X |e verfasserin |4 aut | |
| 700 | 1 | |a Coskun, Bukre C |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Justin C |e verfasserin |4 aut | |
| 700 | 1 | |a Yuh, Esther L |e verfasserin |4 aut | |
| 700 | 1 | |a Mukherjee, Pratik |e verfasserin |4 aut | |
| 700 | 1 | |a Markowitz, Amy J |e verfasserin |4 aut | |
| 700 | 1 | |a Huang, Michael C |e verfasserin |4 aut | |
| 700 | 1 | |a Tarapore, Phiroz E |e verfasserin |4 aut | |
| 700 | 1 | |a Robertson, Claudia S |e verfasserin |4 aut | |
| 700 | 1 | |a Diaz-Arrastia, Ramon |e verfasserin |4 aut | |
| 700 | 1 | |a Stein, Murray B |e verfasserin |4 aut | |
| 700 | 1 | |a Ferguson, Adam R |e verfasserin |4 aut | |
| 700 | 1 | |a Puccio, Ava M |e verfasserin |4 aut | |
| 700 | 1 | |a Okonkwo, David O |e verfasserin |4 aut | |
| 700 | 1 | |a Giacino, Joseph T |e verfasserin |4 aut | |
| 700 | 1 | |a McCrea, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Manley, Geoffrey T |e verfasserin |4 aut | |
| 700 | 1 | |a Temkin, Nancy R |e verfasserin |4 aut | |
| 700 | 1 | |a DiGiorgio, Anthony M |e verfasserin |4 aut | |
| 700 | 0 | |a TRACK-TBI Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Duhaime, Ann-Christine |e investigator |4 oth | |
| 700 | 1 | |a Elguindy, Mahmoud M |e investigator |4 oth | |
| 700 | 1 | |a Fabian, Brian |e investigator |4 oth | |
| 700 | 1 | |a Gopinath, Shankar |e investigator |4 oth | |
| 700 | 1 | |a Grandhi, Ramesh |e investigator |4 oth | |
| 700 | 1 | |a Halabi, Cathra |e investigator |4 oth | |
| 700 | 1 | |a Jain, Sonia |e investigator |4 oth | |
| 700 | 1 | |a Jha, Ruchira M |e investigator |4 oth | |
| 700 | 1 | |a Korley, Frederick K |e investigator |4 oth | |
| 700 | 1 | |a Madden, Christopher |e investigator |4 oth | |
| 700 | 1 | |a Merchant, Randall |e investigator |4 oth | |
| 700 | 1 | |a Ngwenya, Laura B |e investigator |4 oth | |
| 700 | 1 | |a Schnyer, David M |e investigator |4 oth | |
| 700 | 1 | |a Sun, Xiaoying |e investigator |4 oth | |
| 700 | 1 | |a Taylor, Sabrina R |e investigator |4 oth | |
| 700 | 1 | |a Valadka, Alex B |e investigator |4 oth | |
| 700 | 1 | |a van Essen, Thomas A |e investigator |4 oth | |
| 700 | 1 | |a Vassar, Mary J |e investigator |4 oth | |
| 700 | 1 | |a Zafonte, Ross D |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t JAMA network open |d 2018 |g 6(2023), 9 vom: 05. Sept., Seite e2335804 |w (DE-627)NLM289300517 |x 2574-3805 |7 nnns |
| 773 | 1 | 8 | |g volume:6 |g year:2023 |g number:9 |g day:05 |g month:09 |g pages:e2335804 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1001/jamanetworkopen.2023.35804 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 6 |j 2023 |e 9 |b 05 |c 09 |h e2335804 | ||