Prospective Outpatient Follow-Up of Early Cognitive Impairment in Patients with Mild Traumatic Brain Injury and Intracranial Hemorrhage

Mallory Jebbia; Stephen Stopenski; Areg Grigorian; Catherine Kuza; Samuel Bloom; Pranthi Rao; Claudia Alvarez; Matthew Dolich; Ninh Nguyen; Jeffry Nahmias

doi:10.1097/XCS.0000000000001101

Prospective Outpatient Follow-Up of Early Cognitive Impairment in Patients with Mild Traumatic Brain Injury and Intracranial Hemorrhage

J Am Coll Surg. 2024 Apr 25. doi: 10.1097/XCS.0000000000001101. Online ahead of print.

Authors

Affiliations

¹ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California.
² University of California, San Diego, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery.
³ University of Southern California, Los Angeles, Department of Trauma and Acute Care Surgery.

PMID: 38661149
DOI: 10.1097/XCS.0000000000001101

Abstract

Introduction: Mild traumatic brain injury (mTBI) encompasses a spectrum of disability including early cognitive impairment (ECI). The Brain Injury Guidelines (BIG) suggest mTBI patients can be safely discharged from the Emergency Department. Although half of mTBI patients with intracranial hemorrhage (ICH) have evidence of ECI, it is unclear what percentage of these patients' ECI persists after discharge. We hypothesize a significant proportion of trauma patients with mTBI and ECI at presentation have persistent ECI at 30-day follow-up.

Methods: A single-center prospective cohort study including adult trauma patients with ICH or skull fracture plus a Glasgow coma scale (GCS) of 13-15 on arrival was performed. Participants were screened for ECI using the Rancho Los Amigos Scale (RLA), and ECI was defined as a RLA < 8. We compared ECI and non-ECI groups for demographics, injury profile, computed tomography (CT) imaging (e.g., Rotterdam CT score) and outcomes with bivariate analysis. 30-day follow up phone calls were performed to re-evaluate RLA for persistent ECI and concussion symptoms.

Results: From 62 patients with ICH or skull fracture and mTBI, 21 (33.9%) had ECI. Patients with ECI had a higher incidence of subarachnoid hemorrhage (85.7% versus 46.3%, p=0.003) and higher Rotterdam CT score (p=0.004) compared to those without ECI. On 30-day follow up, 6 of 21 patients (26.6%) had persistent ECI. In addition, 7 (33.3%) patients had continued concussion symptoms.

Conclusion: Over one-third of mTBI patients with ICH had ECI. At 30-day post-discharge follow-up over one-fourth of these patients had persistent ECI and 33% had concussion symptoms. This highlights the importance of identifying ECI prior to discharge as a significant portion may have ongoing difficulties reintegrating into work and society.