Long-term outcome in patients with mild traumatic brain injury: a prospective observational study - Zumstein, M. A.; Moser, M.; Mottini, M.; Ott, S. R.; Sadowski-Cron, C.; Radanov, B. P.; Zimmermann, H.; Exadaktylos, A. (J Trauma, 2010)
BACKGROUND: Mild traumatic brain injury (MTBI) is common; up to 37% of adult men have a history of MTBI. Complaints after MTBI are persistent headaches, memory impairment, depressive mood disorders, and disability. The reported short- and long-term outcomes of patients with MTBI have been inconsistent. We have now investigated long-term clinical and neurocognitive outcomes in patients with MTBI (at admission, and after 1 and 10 years). METHODS: Patients of a previous study investigating MTBI short-term outcome were prospectively reassessed after +/-10 year using the same standardized data entry form and validated questionnaire (Beltztest with Beltz Score [BeSc]) for evaluation of Quality of life (QoL) and neurocognitive outcome (higher scores indicate lower QoL). RESULTS: Eighty-six of 176 patients (49%) could be reassessed (n = 75 lost to follow-up; n = 8 second brain trauma; n = 7 death), 10.4 +/- 2 years after initial evaluation. Over time, overall BeSc was significantly increased (5.92 +/- 10.3 [admission] vs. 10.7 +/- 12.8 [1 year] vs. 20.86 +/- 17.1 [10 year]; p < 0.0001); only 54 of 86 patients (62.8%) presented with a normal BeSc. Long-term complaints were fatigue, insomnia, and exhaustion. Ten of eighty-six patients (11.6%) had intracranial injury (ICI) and initial BeSc was almost twofold higher in patients with ICI than in patients without ICI (10.0 +/- 8.4 vs. 5.3 +/- 9.6; p = 0.007). This difference was not seen after 1 year or after 10 years (10.3 +/- 11.6 vs. 10.3 +/- 10.1 and 21.4 +/- 17.3 vs. 16.1 +/- 16.4, respectively). Eight of eighty-six patients (9.3%) lost their jobs because of persistent complaints after MTBI. CONCLUSION: BeSc deteriorates over time; our data suggest a decline in general health and QoL in a substantial proportion of patients (37.2%) 10 years after MTBI. Patients without ICI appear to have a better long-term outcome with regard to subjective complaints and QoL.
Keywords: journalArticle; *Health Status; *Quality of Life; Adolescent; Adult; Aged; Aged, 80 and over; Brain Injuries/epidemiology/*therapy; Female; Follow-Up Studies; Humans; Incidence; Intensive Care Units; Male; Middle Aged; Prognosis; Prospective Studies; Surveys and Questionnaires; Survival Rate/trends; Switzerland/epidemiology; Time Factors; Trauma Severity Indices; Young Adult