Cognitive Outcome 1 Year After Mild Traumatic Brain Injury: Results From the TRACK-TBI Study. (22nd March 2022)

• Record Type: Journal Article
• Authors: Schneider, Andrea L.C.; Huie, J. Russell; Boscardin, W. John; Nelson, Lindsay; Barber, Jason K.; Yaffe, Kristine; Diaz-Arrastia, Ramon; Ferguson, Adam R.; Kramer, Joel; Jain, Sonia; Temkin, Nancy; Yuh, Esther; Manley, Geoffrey T.; Gardner, Raquel C.; Badjatia, Neeraj; Boase, Kim; Duhaime, Ann-Christine; Feeser, V. Ramana; Keene, C. Dirk; McCrea, Michael; Merchant, Randall; Ngwenya, Laura B.; Okonkwo, David; Puccio, Ava; Robertson, Claudia; Schnyer, David; Stein, Murray; Stein, Murray; Vasser, Mary; Yue, John K.; Zafonte, Ross;
• Is Part Of: Neurology. Volume 98:Number 12(2022)
• Publication Date: 2022-03-22
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000200041
• Languages: English
• ISSNs: 0028-3878

Abstract

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.