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Rehabilitation Trajectories and Outcomes in Individuals With Mild Traumatic Brain Injury and Psychiatric Histories

A TRACK-TBI Pilot Study

Bertisch, Hilary, PhD, ABPP-CN; Satris, Gigi, MSc, CCRC; Temkin, Nancy, PhD; Barber, Jason, MS; Manley, Geoffrey T., MD, PhD Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Investigators

The Journal of Head Trauma Rehabilitation: January/February 2019 - Volume 34 - Issue 1 - p 36–44
doi: 10.1097/HTR.0000000000000399
Focus on Clinical Research and Practice

Objective: To determine differences in rehabilitation trajectories and return to work (RTW) and social outcomes in individuals with mild traumatic brain injury (mTBI) with and without significant psychiatric histories at index hospitalization.

Setting: Three level 1 trauma centers participating in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) consortium.

Participants: A total of 305 individuals with index mTBI enrolled in the TRACK-TBI pilot project.

Design: Secondary analysis of data from the TRACK-TBI pilot study.

Main Measures: Chart review and patient/family interview at emergency department (ED) admission, ED clinical data, ED discharge plan, functional interview data at 3- and 6-month outcomes, Trail Making Tests, the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index, the California Verbal Learning Test, Second Edition, and the Craig Handicap Assessment and Reporting Technique.

Results: Controlling for neurological history and CT lesion at ED admission, participants with and without psychiatric histories did not differ in terms of treatment, return to work, or reported social function. Individuals with psychiatric histories demonstrated lower processing speed and reported reduced satisfaction with occupational function at outcome.

Conclusions: Individuals with mTBI and psychiatric histories may require specialized rehabilitation planning to address increased risk for cognitive difficulties and occupational dissatisfaction at outcome. CT lesion may independently influence outcomes.

Rusk Rehabilitation, New York University School of Medicine, New York (Dr Bertisch); Brain and Spinal Injury Center (B.A.S.I.C.), Zuckerberg San Francisco General and Trauma Center, University of California, San Francisco (Ms Satris); Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington (Dr Temkin); Department of Neurological Surgery, University of Washington, Seattle, Washington (Mr Barber); Department of Neurological Surgery, University of California, San Francisco, California (Dr Manley).

Corresponding Author: Hilary Bertisch, PhD, ABPP-CN, Rusk Rehabilitation, New York University Langone Medical Center, Ambulatory Care Center, 240 East 38th St, 17th Floor, New York, NY 10016 (hilary.bertisch@nyumc.org).

The authors thank the TRACK-TBI investigative team including the following: Opeolu M. Adeoye, MD, University of Cincinnati; Neeraj Badjatia, MD, University of Maryland, Baltimore; Kimberly D. Boase, BA, University of Washington; Yelena Bodien-Guller, PhD, Harvard/Spaulding Rehabilitation Hospital; Malcolm R. Bullock, MD, PhD, University of Miami; Randall M. Chesnut, MD, FCCM, FACS, University of Washington; John D. Corrigan, PhD, Ohio State University; Karen L. Crawford, MILS, University of Southern California; Ramon Diaz-Arrastia, MD, University of Pennsylvania; Sureyya S. Dikmen, PhD, University of Washington; Ann-Christine Duhaime, MD, Harvard/Massachusetts General Hospital; Richard G. Ellenbogen, MD, FACS, University of Washington; Frank Ezekiel, University of California, San Francisco; Venkata R. Feeser, MD, Virginia Commonwealth University; Etienne Gaudette, PhD, University of Southern California; Joseph T. Giacino, PhD, Harvard/Spaulding Rehabilitation Hospital; Dana P. Goldman, PhD, University of Southern California; Luis Gonzales, BA, TIRR Memorial Hermann; Shankar P. Gopinath, MD, Baylor College of Medicine; Rao P. Gullapalli, PhD, MBA, University of Maryland, Baltimore; Jesse C. Hemphill, MD, University of California, San Francisco; Gillian A. Hotz, PhD, University of Miami; Joel H. Kramer, PsyD, University of California, San Francisco; Harvey Levin, PhD, Baylor College of Medicine; Christopher J. Lindsell, PhD, Vanderbilt University; Joan Machamer, MA, University of Washington; Christopher Madden, MD, UT Southwestern; Amy J. Markowitz, JD, University of California, San Francisco; Alastair Martin, PhD, University of California, San Francisco; Bruce E. Mathern, MD, Virginia Commonwealth University; Thomas W. McAllister, MD, Indiana University; Michael A. McCrea, PhD, Medical College of Wisconsin; Randall E. Merchant, PhD, Virginia Commonwealth University; Florence Noel, PhD, Baylor College of Medicine; Daniel P. Perl, MD, Uniformed Services University of the Health Sciences; Ava M. Puccio, RN, PhD, University of Pittsburgh; Miri Rabinowitz, PhD, University of Pittsburgh; Claudia S. Robertson, MD, Baylor College of Medicine; Jonathan Rosand, MD, MSC, Harvard/Massachusetts General Hospital; Angelle M. Sander, PhD, Baylor College of Medicine; David M. Schnyer, PhD, UT Austin; Seth A. Seabury, PhD, University of Southern California; Paulina Sergot, MD, FACEP, Baylor College of Medicine; Mark Sherer, PhD, TIRR Memorial Hermann; Deborah M. Stein, MD, MPH, University of Maryland, Baltimore; Murray B. Stein, MD, MPH, FRCPC, University of California, San Diego; Sabrina R. Taylor, PhD, University of California, San Francisco; Arthur W. Toga, PhD, University of Southern California; L. Christine Turtzo, MD, PhD, Uniformed Services University of the Health Sciences; Paul M. Vespa, MD, University of California, Los Angeles; Kevin K. Wang, PhD, University of Florida; John K. Yue, MD, University of California, San Francisco; Ross Zafonte, DO, Harvard/Spaulding Rehabilitation Hospital; Zhiqun Zhang, MD, University of Florida.

The authors declare no conflicts of interest.

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