Distinct symptom recoveries based upon highest level of care in patients with sport-related concussion or traumatic brain injury and Glasgow Coma Scale 13–15

Abstract

There are limited data directly comparing recovery across traumatic brain injury subpopulations. We compared symptom recovery profiles between patients with Glasgow Coma Scale (GCS) 13–15 traumatic brain injury (TBI) from the same region in three cohorts: (1) Participants with sport-related concussion (SRC), (2) participants evaluated and discharged from the level 1 trauma center emergency department (ED), and (3) participants who required 1 + night(s) in the inpatient unit (IP). The current analysis aggregates data from two prospective cohort studies at the same institution resulting in a combined dataset of 395 patients with TBI (224 with SRC, 95 discharged from the ED, and 75 admitted [IP]). The primary outcome measure of interest was self-reported TBI symptom duration (in days). Two multivariable Cox proportional hazards models evaluated differences in symptom recovery between groups while controlling for recovery risk factors, including age, sex, race/ethnicity, acute symptom severity, psychological disorder history, loss of consciousness, and post-traumatic amnesia. The second model included only ED and IP, due to availability of additional predictor variables in these samples (e.g., education, cause of injury, peripheral injury severity). In unadjusted models, hazards of symptom recovery were lower with increasing levels of care (IP vs. ED HR=.40, p < .001; IP vs. SRC HR=.11, p < .001, ED vs. SRC HR=.28, p < .001). Controlling for covariates, longer symptom recovery in the trauma center subsamples versus SRC persisted (IP vs. SRC HR=.26, p = .018, ED vs. SRC HR=.52, p = .021), whereas differences between ED and IP became nonsignificant (HR=.86, p = .782). Acute symptom severity (HR=0.98; p < 0.001–0.010) and psychiatric history (HR=0.27–0.36; p ≤ 0.034) were independent predictors of symptom duration in both models. The results of this study suggest that patients with TBI and GCS 13–15 seen at a level 1 trauma center vary significantly in symptom recovery and severity in comparison to those with SRC, regardless of population differences in age, sex and psychiatric history.