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Early prediction of favorable recovery six-months after mild traumatic brain injury
  1. Maja Stulemeijer (maja.stulemeijer{at}live.nl)
  1. Raboud University Nijmegen Medical Centre, Department of Medical Psychology, Netherlands
    1. Sieberen P van der Werf (s.vanderwerf{at}neuro.umcn.nl)
    1. University Medical Centre Nijmegen, Department of Medical Psychology, Netherlands
      1. George F Borm (g.borm{at}neuro.umcn.nl)
      1. Raboud University Nijmegen Medical Centre, Department of Epidemiology and Biostatistics, Netherlands
        1. Pieter E Vos (p.vos{at}neuro.umcn.nl)
        1. Raboud University Nijmegen Medical Centre, Department of Neurology, Netherlands

          Abstract

          Background: Predicting outcome after Mild Traumatic Brain Injury (MTBI) is notoriously difficult. Although it is recognized that milder head injuries do not necessarily mean better outcomes, less is known about the factors that do enable early identification of patients who are likely to recover well.

          Objective: To develop and internally validate two prediction rules for identifying patients who have a high chance for good six-month recovery.

          Methods: A prospective cohort study was conducted among ED-admitted MTBI patients. Besides MTBI severity indices, a range of pre-, peri- and early post injury variables were considered as potential predictors, including emotional and physical functioning. Logistic regression modeling was used to predict the absence of postconcusional symptoms (PCS) and full return to work (RTW).

          Results: At follow-up, 64% of the 201 participating patients reported full recovery. Based on our prediction rules, patients without pre-morbid physical problems, low levels of PCS and post traumatic stress early after injury, had 90% chance to remain free of PCS. Patients with over 11 years of education, without nausea or vomiting on admission, with no additional extracranial injuries, and only low levels of pain early after injury, had 90% chance on full RTW. The discriminative ability of the prediction models was satisfactory with an area under the curve > 0.70 after correction for optimism.

          Conclusions: Early identification of MTBI patients who are likely to have good six-month recovery was feasible on the basis of relatively simple prognostic models. A score chart was derived from the models to facilitate clinical application.

          • closed
          • head Injuries
          • prognosis
          • risk factors

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