New Research Suggests Treating Traumatic Brain Injury as a Chronic Illness

By Jonathan Springston, Editor, Relias Media

The authors of a recently published paper found those who sustain a traumatic brain injury (TBI) might demonstrate signs of decline — or improvement — for years after the injury, suggesting such trauma is more than a one-off event followed by brief recovery.

In the TRACK-TBI LONG study, researchers investigated more than 1,000 patients from 18 U.S. Level I trauma centers who had sustained TBI (average age = 41 years; mild TBI = 917 patients; moderate to severe TBI = 193 patients). The authors matched these patients with 154 additional participants who had sustained orthopedic injuries but no head injuries.

Researchers prospectively enrolled patients in their study within 24 hours of sustaining the head injury and followed these patients for up to one year. Investigators created a subgroup of these patients whom they followed between two and seven years. Study participants completed a post-injury baseline assessment and additional follow-up interviews over time.

Investigators administered tests on thinking, memory, mental health, and the ability to function with daily activities annually from two to seven years post-injury. Patients also completed an interview on their abilities and symptoms, including headache, fatigue, and sleep disturbances.

After reviewing all the combined test scores, researchers noted 21% of patients with mild TBI experienced decline vs. 26% of patients with moderate to severe TBI vs. 15% of patients with orthopedic injuries but no head injury. The steepest declines centered on ability to function with daily activities (29% mild TBI patients and 23% moderate to severe TBI patients declined over two to seven years follow-up).

However, researchers also noted some participants improved — 22% of patients with mild TBI improving over time and 36% of patients with moderate to severe TBI improving over time.

Among patients with mild TBI, there was more functional decline among patients who were retired, disabled, or not working vs. those working full-time or part-time jobs. Patients with mild TBI who identified as Black and scored higher on the Brief Symptom Inventory-18 assessment were more likely to show better psychiatric symptoms. For patients with moderate to severe TBI, those who had attained more education were more likely to demonstrate cognitive improvement.

“These findings point out the need to recognize TBI as a chronic condition in order to establish adequate care that supports the evolving needs of people with this condition,” said study author Benjamin L. Brett, PhD, of the Medical College of Wisconsin in Milwaukee. “This type of care should place a greater emphasis on helping people who have shown improvement continue to improve and implementing greater levels of support for those who have shown decline.”

For more on this and related subjects, be sure to read the latest issues of Neurology Alert and Trauma Reports.