Population-based, inception cohort study of the incidence, course, and prognosis of mild traumatic brain injury after motor vehicle collisions

Abstract

OBJECTIVE:

To determine the incidence, course, and prognosis of adult mild traumatic brain injury (MTBI) caused by motor vehicle collisions.

DESIGN:

Prospective, population-based, inception cohort study.

SETTING:

The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.

PARTICIPANTS:

All adults (N=1716) incurring an MTBI in a motor vehicle collision between November 1997 and December 1999 in Saskatchewan.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Age- and sex-stratified incidence rates, time to self-reported recovery, and prognostic factors over a 1-year follow-up.

RESULTS:

Of 7170 adults injured in a motor vehicle collision over the 2-year inception period, 1716 (24%) met our cohort definition of MTBI. There were more women affected (53%), and MTBI was most common in the 18- to 23-year-old group. Most were not hospitalized (73%), but 28% reported loss of consciousness and 23% reported posttraumatic amnesia. The annual incidence of MTBI per 100,000 adults was 106.1 (95% confidence interval [CI], 98.9-113.6) in the first year and 118.3 (95% CI, 110.8-126.3) in the second year of the study. The 1-year follow-up rate was 84%. The median time to recovery was 100 days (95% CI, 97-103), and about 23% reported not having recovered by 1 year. Factors associated with delayed recovery included being older than 50 years, having less than a high school education, having poor expectations for recovery, having depressive symptoms, having arm numbness, having hearing problems, having headaches, having lowback pain, and having thoracic back pain. Loss of consciousness and posttraumatic amnesia were not associated with recovery.

CONCLUSIONS:

MTBI affects almost a quarter of persons reporting an injury after a traffic collision. The median time to recovery is 100 days, but 23% have still not recovered by 1 year. A mix of biopsychosocial factors is associated with recovery, including a strong effect of poor expectations for recovery.

Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Brain concussions, Cohort studies, Epidemiology, Incidence, Prognosis, Recovery of function, Rehabilitation

Type 1 Modic changes was a significant risk factor for 1 year outcome in sick-listed low back pain patients: a nested cohort study using magnetic resonance imaging of the lumbar spine

Abstract

BACKGROUND CONTEXT:

It is not clear whether Modic changes (MC) is associated with low back pain (LBP) outcome.

PURPOSE:

To study associations between baseline degenerative manifestations and outcome in sick-listed LBP patients.

STUDY DESIGN:

Prospective nested cohort study based on a randomised controlled trial.

PATIENT SAMPLE:

Out of 325 sick-listed LBP patients, 141 patients were consecutively examined by magnetic resonance imaging (MRI) and included, and 140 patients completed the study.

OUTCOME MEASURES:

Degenerative manifestations of the lumbar spine were quantified, and associations were studied in relation to the three primary outcomes 1) change of back+leg pain and 2) change of function as measured by Roland-Morris questionnaire and 3) one-year U-RTW.

METHODS:

By using a previously validated MRI-protocol, a specialist in radiology, who had no access to clinical data, described the images. Associations were studied by linear and logistic regression with adjustment for previously identified prognostic factors for one-year pain and function and for unsuccessful return to work (U-RTW).

RESULTS:

Clinically, 43% of the patients had radiculopathy. Degenerative changes were prevalent with altered disc contours in 84%, high intensity zones in 70% and nerve root touch or impingement in 63% of the patients. MC was identified in 60% of the patients, 18% with type 1 changes and 42% with type 2 changes, type 1 including both type 1 and type 1 in combination with type 2. Patients with type 1 changes reported more back pain and did not improve in pain or disability. They increased to include 30% of the patients with U-RTW at one year. Patients with type 2 changes did not differ significantly from patients without MC, but differed significantly from patients with type 1 changes in all three outcomes. Other degenerative manifestations were not significantly associated with any of the three outcomes.

CONCLUSIONS:

The only degenerative manifestation negatively associated with outcome was type 1 MC which affected 18% of the cohort at baseline and implied an increased risk for no improvement in pain and function and for U-RTW, even after adjustment for other prognostic factors.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Low back pain, Modic changes, disc herniation, prognosis, return to work, sick-listing

PMID:

 

24534386

 

[PubMed - as supplied by publisher]