Complicated mild traumatic brain injury in older adults: Post-concussion symptoms and functional outcome at one week post injury

ABSTRACT

Primary Objective: Mild Traumatic Brain Injury (MTBI) is commonly categorized as complicated when injury severity criteria are mild, but an intracranial abnormality is present on acute neuroimaging. The current study examined whether functional outcomes differed at one week post injury among older adult patients based on injury severity and acute computed tomography (CT) findings.

Research Design: Participants (≥55 years-old; n = 173) presenting sequentially to the emergency department with a head injury were divided into three groups: complicated MTBI (positive CT; n = 22), uncomplicated MTBI (negative CT; n = 68), and mild head injury (unperformed CT, no documented loss of consciousness or post-traumatic amnesia; n = 83).

Methods and Procedures: At one week post injury, the Modified Rankin Scale (i.e., difference score between pre/post-injury ratings; ∆MRS), Glasgow Outcome Scale-Extended (GOS-E), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) were administered.

Main Outcomes and Results: Participants differed on the ∆MRS and GOS-E, but not the RPQ. The complicated MTBI group had worse GOS-E ratings than the uncomplicated MTBI and mild head injury groups and worse ∆MRS than the mild head injury group, but the uncomplicated MTBI and mild head injury groups did not differ on either outcome.

Conclusions: Macrostructural abnormality on CT was associated with worse functional outcome at one week post MTBI.

KEYWORDS:

• Mild brain injury
• neuroimaging
• outcome
• functional status
• post-concussion syndrome

Acknowledgments

The authors acknowledge research assistant Anne Simi for her assistance with the patient enrollment and data collection at Tampere University Hospital.

Declaration of Interest Statement

The study was financially supported by the Finnish State Research Funding and the Finnish Medical Society Duodecim. Teemu Luoto, M.D., Ph.D. has received funding from the Government’s Special Financial Transfer tied to academic research in Health Sciences (Finland). Grant Iverson, Ph.D. has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received salary support from the National Football League and the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He serves as a scientific advisor for Sway Operations, LLC, Highmark, Inc., and BioDirection, Inc. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Heinz Family Foundation, and the Mooney-Reed Charitable Foundation.

Additional information

Funding

This work was supported by the Finnish State Research Funding and the Finnish Medical Society Duodecim.