Journal
JOURNAL OF HEAD TRAUMA REHABILITATION
Volume 35, Issue 6, Pages E513-E523Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/HTR.0000000000000575
Keywords
brain injury severity; depression; extracranial injury; GOSE; multiple trauma; neurocognitive function; quality of life; traumatic brain injury
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Funding
- Medical Research Council (MRC, United Kingdom) Program Grant (Acute Brain Injury: Heterogeneity of Mechanisms, Therapeutic Targets) [G9439390 ID 65883]
- European Commission [FP7-270259-TBIcare]
- UK National Institute of Health Research (NIHR) Biomedical Research Centre at Cambridge
- UK Department of Health
- Engineering and Physical Sciences Research Council (EPSRC, United Kingdom) Pathways to Impact award
- Academy of Finland-grant [17379]
- Emil Aaltonen Foundation
- Finnish Brain Foundation
- Maire Taponen Foundation
- NIHR Brain Injury MedTech Co-operative, Cambridge
- NIHR Cambridge Biomedical Research Centre (Mental Health Theme)
- NIHR through the NIHR Cambridge Biomedical Research Centre grant - Health Foundation/Academy of Medical Sciences Clinician Scientist Fellowship
- UK National Institute of Health Research (NIHR) Biomedical Research Centre at Cambridge, the Technology Platform
- NIHR
- MRC [G9439390] Funding Source: UKRI
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Objective: To determine the effect of extracranial injury (ECI) on 6-month outcome in patients with mild traumatic brain injury (TBI) versus moderate-to-severe TBI. Participants/Setting: Patients with TBI (n = 135) or isolated orthopedic injury (n = 25) admitted to a UK major trauma center and healthy volunteers (n = 99). Design: Case-control observational study. Main Measures: Primary outcomes: (a) Glasgow Outcome Scale Extended (GOSE), (b) depression, (c) quality of life (QOL), and (d) cognitive impairment including verbal fluency, episodic memory, short-term recognition memory, working memory, sustained attention, and attentional flexibility. Results: Outcome was influenced by both TBI severity and concomitant ECI. The influence of ECI was restricted to mild TBI; GOSE, QOL, and depression outcomes were significantly poorer following moderate-to-severe TBI than after isolated mild TBI (but not relative to mild TBI plus ECI). Cognitive impairment was driven solely by TBI severity. General health, bodily pain, semantic verbal fluency, spatial recognition memory, working memory span, and attentional flexibility were unaffected by TBI severity and additional ECI. Conclusion: The presence of concomitant ECI ought to be considered alongside brain injury severity when characterizing the functional and neurocognitive effects of TBI, with each presenting challenges to recovery.
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