P078: Derivation and validation of a non return to work predictive model three months after a mild traumatic brain injury

Introduction: Mild traumatic brain injury (mTBI) is a common problem and until now, ED physicians don’t have any tool to predict when the patient will return to work. The purpose of this study is to develop and validate a clinical decision rule to identify the ED patients who are at risk of non-return to work or to school three months after a mTBI. Methods: Patients were recruiting in five Level I and II Trauma Centers ED in the province of Québec. All patients were referred for a systematic telephone follow-up after three months. Information about their return to work/school, partial or complete, was collected. Log binomial regression was used to develop a predictive model and the validation of this model was performed on a different prospective cohort. Results: 13,7% of the patients did not return to work/school at three months. The final model was derived from a prospective cohort of 398 patients and included three risk factors: motor vehicle accident (2 points), loss of consciousness (1 point) and headache during the emergency department assessment (1 point). With a one-point threshold, this model has a sensitivity of 97% and a negative predictive value (NPV) of 98%. However, the specificity is only 23% and the positive predictive value (PPV) is 17%. The area under the curve is 0.786. Validation of the model was performed with a new prospective cohort of 517 patients, and demonstrated a sensitivity of 86% and a NPV of 91%. Conclusion: Although this model is not very specific, its high sensitivity and NPV indicate to the clinician that mTBI patients who don’t have any of the three criteria are at low risk of prolonged work stoppage after their trauma.

Download Full-text

Mild traumatic brain injury from motor vehicle accidents: Factors associated with return to work

Archives of Physical Medicine and Rehabilitation ◽

10.1016/s0003-9993(99)90275-7 ◽

1999 ◽

Vol 80 (4) ◽

pp. 392-398 ◽

Cited By ~ 63

Author(s):

Carol F. Ruffolo ◽

Judith F. Friedland ◽

Deirdre R. Dawson ◽

Angela Colantonio ◽

Peter H. Lindsay

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Return To Work ◽

Mild Traumatic Brain Injury ◽

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Factors Associated ◽

Vehicle Accidents

Download Full-text

The Mild Traumatic Brain Injury Rest and Activity Questionnaire (MTBI-RAQ): A Pilot Study

Brain Impairment ◽

10.1017/brimp.2018.5 ◽

2018 ◽

Vol 19 (2) ◽

pp. 141-152 ◽

Cited By ~ 2

Author(s):

Karen A. Sullivan ◽

Rebecca Cox

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Vehicle Accident ◽

Cut Score ◽

History Of ◽

Cognitive Behaviours ◽

Adult Volunteers

Objective: To develop a tool for assessing intentions to continue or change activities for recovery following mild traumatic brain injury (mTBI) and determine if they are dependent on injury context or activity type. Method: Adult volunteers with no (or no recent) history of mTBI were randomly allocated to one of two vignette conditions, each with a different injury context. The vignette described an mTBI due to a motor vehicle accident (MVA, n = 76) or sport (SPORT, n = 89). Volunteers reported their rest or activity plans for 39 behaviours comprising three behaviour types (cognitive, physical, and restful). Results: Compared to a cut-score representing no change, on average there was a significant (p <= .001) planned decrease in physical and cognitive behaviours (MVAphysicalt(53) = 7.373; SPORTphysicalt(41) = 9.281; MVAcognitivet(41) = 9.367; SPORTcognitivet(51) = −3.521) and a significant planned increase in restful behaviours, such as sleep (MVArestfult(72) = 10.006; SPORTrestfult(86) = 9.566). An overall within-group effect for behaviour-type was not identified and there was no effect of condition (MVA vs. SPORT). Conclusion: The acute rest and activity plans for a simulated mTBI are behaviour specific and not dependent on context. An expectation for blanket-rest was not was observed but rest was planned for specific behaviours. This tool could be used to guide discussions with mTBI patients about their recovery so that their plans align with advice, and it could aid further research into the relation between intended and actual rest and activity and the effect on eventual outcomes.

Download Full-text

Factors influencing outcome following mild traumatic brain injury in adults

Journal of the International Neuropsychological Society ◽

10.1017/s1355617700655066 ◽

2000 ◽

Vol 6 (5) ◽

pp. 568-579 ◽

Cited By ~ 360

Author(s):

JENNIE PONSFORD ◽

CATHERINE WILLMOTT ◽

ANDREW ROTHWELL ◽

PETER CAMERON ◽

ANN-MAREE KELLY ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Visual Disturbance ◽

Mild Tbi ◽

Neuropsychological Measures ◽

Severity Of Injury ◽

Minor Injuries

This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS–R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI. (JINS, 2000, 6, 568–579.)

Download Full-text