Predictors of Poor Outcome After Traumatic Brain Injury

The outcome following traumatic brain injury (TBI) is often unpredictable and variable.

Two individuals with similar types of TBI can have quite different outcomes ranging from total disability to functional employment.

Torun Finnanger and colleagues from Norway and Australia recently reported on a study that examined a number of predictor variables on self-reported outcome following TBI.

In this study, 67 adolescents and adults with moderate to severe TBI completed baseline assessments and were followed for a period of 2 to 5 years. 

The key outcome variables in this study was self-reported executive, behavioral and emotional impairment at the follow-up time point. TBI subjects were compared on a variety of variables with a control group without injury.

Early assessment variables that were examined for correlation with outcome after TBI included:

• Pre-trauma level of education
• Brain injury severity rating: Glasgow Coma Score
• Duration of post-traumatic amnesia
• Brain imaging: presence of imaging markers for brain traumatic axonal injury on brain MRI with inclusion of diffusion tensor imaging (DTI) data
• Neuropsychological assessment obtained three months after injury including: Motor function, information processing speed, attention, visual memory, verbal memory and executive function
• Presence of the symptoms of depression using Beck Depression Inventory 3 and 12 months after injury

The key findings from this longitudinal predictor study included:

• Self-reported impairment in executive function at 2-5 years follow up was linked to fewer years of education, early depression symptoms and traumatic axonal injury
• Injury at a younger age predicted increased aggression and conduct disorder behavioral problems
• Traumatic axonal injury and early depression symptoms predicted increased depression and anxiety symptoms at follow up.

The authors conclude their study supports inclusion of self-reported executive, emotional and behavioral assessments in the monitoring of TBI subjects.

Additionally, they note early MRI imaging assessment of axonal injury (in the first two weeks following TBI) and early assessment of depressive symptoms add information to standard neuropsychological assessment batteries.

They note accurately defining high-risk groups more poor outcome may allow targeting of more aggressive treatment strategies. 

"Furthermore, psychological and/or pharmaceutical interventions, with a focus on depressive symptomatology may be helpful in reducing the long-term problems experienced by persons sustaining a TBI.."

This study is filled with a ton of data. Readers with more interest in the study can find the free full-text manuscript by clicking on the PMID link in the citation below.

Follow the author on Twitter WRY999.

Image of brain white matter pathways is an iPad screen shot from the 3D Brain app from the authors files.

Finnanger TG, Olsen A, Skandsen T, Lydersen S, Vik A, Evensen KA, Catroppa C, Håberg AK, Andersson S, & Indredavik MS (2015). Life after Adolescent and Adult Moderate and Severe Traumatic Brain Injury: Self-Reported Executive, Emotional, and Behavioural Function 2-5 Years after Injury. Behavioural neurology, 2015 PMID: 26549936