Symptomatology and Functional Outcome in Mild Traumatic Brain Injury: Results from the Prospective TRACK-TBI Study

TLDR

Mild traumatic brain injury (mTBI) or concussion is a major public health concern, yet the true incidence of postconcussion syndrome (PCS) remains controversial due to its diverse physical, cognitive, emotional, and sleep symptoms. This study aims to describe the incidence and trajectory of PCS symptoms and functional outcomes at 3, 6, and 12 months in a large prospective mTBI cohort. Using the prospective, multi‑center TRACK‑TBI study, 375 mTBI patients (GCS 13–15) presenting to emergency departments—including those with negative head CT and discharged home—were followed over one year. At 6 and 12 months, 82 % of patients reported at least one PCS symptom, 44.5 % and 40.3 % had significantly lower Satisfaction With Life scores, 33 % were functionally impaired at 3 months, and 22.4 % remained below full functional status at 1 year, underscoring that “mild” is a misnomer and highlighting the need for revised TBI classification.

Abstract

Mild Traumatic Brain Injury (mTBI), or concussion, is a major public health concern. There is controversy in the literature regarding the true incidence of postconcussion syndrome (PCS), with the constellation of physical, cognitive, emotional, and sleep symptoms after mTBI. In the current study, we report on the incidence and evolution of PCS symptoms and patient outcomes after mTBI at 3, 6, and 12 months in a large, prospective cohort of mTBI patients. Participants were identified as part of the prospective, multi-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study. The study population was mTBI patients (Glasgow Coma Scale score of 13–15) presenting to the emergency department, including patients with a negative head computed tomography discharged to home without admission to hospital; 375 mTBI subjects were included in the analysis. At both 6 and 12 months after mTBI, 82% (n=250 of 305 and n=163 of 199, respectively) of patients reported at least one PCS symptom. Further, 44.5 and 40.3% of patients had significantly reduced Satisfaction With Life scores at 6 and 12 months, respectively. At 3 months after injury, 33% of the mTBI subjects were functionally impaired (Glasgow Outcome Scale-Extended score ≤6); 22.4% of the mTBI subjects available for follow-up were still below full functional status at 1 year after injury. The term "mild" continues to be a misnomer for this patient population and underscores the critical need for evolving classification strategies for TBI for targeted therapy.