Influence of Concomitant Extracranial Injury on Functional and Cognitive Recovery From Mild Versus Moderateto Severe Traumatic Brain Injury.
Carroll, Ellen L
Manktelow, Anne E
The Journal of head trauma rehabilitation
Wolters Kluwer Health
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Carroll, E. L., Manktelow, A. E., Outtrim, J., Chatfield, D., Forsyth, F., Hutchinson, P., Tenovuo, O., et al. (2020). Influence of Concomitant Extracranial Injury on Functional and Cognitive Recovery From Mild Versus Moderateto Severe Traumatic Brain Injury.. The Journal of head trauma rehabilitation, 35 (6), E513-E523. https://doi.org/10.1097/htr.0000000000000575
Abstract Objective: To determine the effect of extracranial injury (ECI) on six-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 relative to 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.
Funding: This work was partially funded by a Medical Research Council (MRC, UK) Program Grant (Acute brain injury: heterogeneity of mechanisms, therapeutic targets and outcome effects [G9439390 ID 65883]), the European Commission under the 7th Framework Programme (FP7-270259-TBIcare), the UK National Institute of Health Research (NIHR) Biomedical Research Centre at Cambridge, the Technology Platform funding provided by the UK Department of Health and an Engineering and Physical Sciences Research Council (EPSRC, UK) Pathways to Impact award. PJH was supported by the NIHR (Research Professorship and Cambridge BRC). JPP received funding from Academy of Finland – Grant #322381, Government’s Special Financial Transfer tied to academic research in Health Sciences (Finland), the Emil Aaltonen Foundation, the Finnish Brain Foundation and the Maire Taponen Foundation. BJS receives funding from the NIHR Brain Injury MedTech Co-operative, Cambridge and the NIHR Cambridge Biomedical Research Centre (Mental Health Theme). DKM was supported by the NIHR through the NIHR Cambridge Biomedical Research Centre grant and a Senior Investigator Award. VFJN was funded by a Health Foundation/Academy of Medical Sciences Clinician Scientist Fellowship. Acknowledgements: The NIHR/Wellcome Trust Cambridge Clinical Research Facility provided nursing support to aid in the patient recruitment and data collection within the Emergency Department.
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External DOI: https://doi.org/10.1097/htr.0000000000000575
This record's URL: https://www.repository.cam.ac.uk/handle/1810/301181
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