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D6-05
SYMPTOM ATTRIBUTION AFTER MILD TRAUMATIC
BRAIN INJURY
William Panenka
, Noah Silverberg
University of British Columbia, Psychiatry, Vancouver, Canada
Over-attributing headache, fatigue, concentration difficulty and other
symptoms to mild traumatic brain injury (MTBI), instead of benign
causes such as daily stress, is thought to impede recovery. The present
study examines symptom attribution after MTBI and its correlates. The
sample consisted of highly symptomatic patients seeking treatment for
MTBI at an outpatient concussion clinic 23.9 days (SD
=
7.9) post-injury
(N
=
30; 60% female). As part of a clinical trial, a prognostic algorithm
was applied to consecutive cases and only those at high risk for chronic
symptoms were included. In the baseline assessment, participants com-
pleted the Rivermead Post Concussion Symptoms Questionnaire (RPQ)
and then rated the degree to which each symptom was caused by their
MTBI on a scale ranging from 0 (not at all) to 4 (entirely). Participants
reported a median of 13 symptoms (IQR: 9 to 15) and attributed a median
of 12 symptoms (IQR: 8 to 14) mostly or entirely to MTBI. One quarter
of the sample (26.7%, n
=
8) attributed every symptom to MTBI. Head-
aches, dizziness, nausea, slowed thinking, and double vision were vir-
tually always (
>
95%) attributed to MTBI. Sleep disturbance and
depressed mood were least often (80%) attributed to MTBI. RPQ total
scores were associated with a higher number of symptoms attributed to
MTBI (r
=
.431, p
=
.017) and a stronger degree of attribution (r
=
.873,
p
<
.001). Adjusting for symptom severity, patients who attributed every
one of their symptoms to MTBI were
less
anxious (Hospital Anxiety and
Depression Scale
=
7.48 vs. 11.33, p
=
.025, Cohen’s d
=
0.61), had sim-
ilar expectations for recovery on the Illness Perception Questionnaire-
Revised (14.09 vs. 15.60 p
=
.352, Cohen’s d
=
0.25), and were no more
likely to be litigating (
v
2
(1)
=
.29, p
=
.59). In conclusion, patients who
report more symptoms after MTBI tend to believe MTBI is the primary
cause. However, over-attributing symptoms to MTBI was not associated
with known risk factors for chronic post-concussion syndrome, and so
may not be involved in the development of this condition.
Keywords: MTBI, Symptom Attribution, Concussion, Symptom
Severity
D6-06
TEMPORAL PROFILE OF CARE FOLLOWING MILD
TRAUMATIC BRAIN INJURY: PREDICTORS TO HOSPITAL
ADMISSION, OUTPATIENT REFERRAL AND OUTCOME
John Yue
1
, Sourabh Sharma
1
, Ethan Winkler
1
, Mary Vassar
1
,
Jonathan Rick
1
, Jonathan Ratcliff
2
, Opeolu Adeoye
2
, Adam
Ferguson
1
, Hester Lingsma
3
, Frederick Korley
4
, Gabriela Satris
1
,
Caitlin Robinson
1
, Esther Yuh
1
, Pratik Mukherjee
1
, Thomas
McAllister
5
, Ramon Diaz-Arrastia
6
, Alex Valadka
7
, Wayne Gordon
8
,
David Okonkwo
9
, Geoffrey Manley
1
1
UCSF, Neurosurgery, San Francisco, USA
2
Univ. Cincinnati, Emergency Medicine, Cincinnati, USA
3
Erasmus, Public Health, Rotterdam, Netherlands
4
Johns Hopkins Univ., Emergency Medicine, Baltimore, USA
5
Univ. Indiana, Psychiatry, Indianapolis, USA
6
USUHS, Neurology, Bethesda, USA
7
Seton Brain & Spine Institute, Neurosurgery, Austin, USA
8
Mount Sinai Hospital, Rehabilitation, New York, USA
9
Univ. Pittsburgh, Neurosurgery, Pittsburgh, USA
To date, guidelines for medical follow-up after mild traumatic brain
injury (mTBI) are not defined, and better characterization of the tem-
poral relationship between hospital admission, outpatient care, and re-
covery after mTBI is needed. We utilized the TRACK-TBI Pilot study
to evaluate characteristics of mTBI patients 1) triaged to hospital ad-
mission, 2) referred to 3-month outpatient care, and 3) assessed with 6-
month functional disability (GOSE
<
7). Adult patients with GCS 13–
15, Marshall Score 1–2, without neurosurgical intervention and alive at
6-months post-injury were included. Of 168 patients (age 44.5
–
17.9
years, 69% male), 48% were admitted to hospital, 22% received out-
patient care, and 27% reported 6-month functional disability. In-
tracranial lesion on CT (odds ratio (OR) 81.08, 95% CI [10.28–639.36])
and post-traumatic amnesia (
>
30min-vs.-
<
30min: OR 5.27 [1.75–
15.87]; unknown-vs.-
<
30min: OR 4.43 [1.26–15.64]) predicted hos-
pital admission after adjusting for age, employment, anticoagulant use,
and prior medical history (PMH). Age (OR 1.03 [1.00–1.05]) and
employment (part-time/unemployed-vs.-full-time: OR 0.17 [0.06–0.50])
predicted 3-month outpatient referral after adjusting for gender and
PMH. Education years (OR 0.86 [0.76–0.97]), GCS
<
15 (OR 2.46
[1.05–5.78]), and PMH of seizures (OR 3.62 [1.21–10.89]) predicted
6-month functional disability after adjusting for psychiatric history. The
analysis demonstrates that while clinical factors modulate triage to
admission, PMH and socioeconomic factors modulate medical follow-
up. Underlying reasons for this divergence need further clarification for
better triage and resource allocation.
Keywords: Clinical Trial, Human Studies, Outcome, Mild TBI
D6-07
OPTIMIZING ENVIRONMENTAL ENRICHMENT TO MOD-
EL PRECLINICAL NEUROREHABILITATION
Megan J. LaPorte, Sonya Besagar, Jeffrey P. Cheng, Corina O. Bondi,
Anthony Kline
University of Pittsburgh, Department of Physical Medicine & Re-
habilitation, Pittsburgh, USA
Traumatic brain injury (TBI) affects 1.7 million people in the USA
each year. One therapeutic strategy that has been investigated is en-
vironmental enrichment (EE), which consists of a complex living
space that confers cognitive and motor recovery when provided early
and continuously after TBI vs. standard (STD) housing. Furthermore,
6-hours of EE/day introduced immediately after TBI is also sufficient
to promote neurobehavioral recovery. However, these paradigms are
not clinically ideal as patients, especially those with moderate-to-
severe TBI, will not be able to engage in rehabilitation until after
critical care has ended. Furthermore, once rehabilitation is initiated
the duration of the therapy is limited, often ranging from 3–6 hours/
day. Hence, refinement of the current model of EE such that it con-
forms more closely to that seen in real-world rehabilitation practice is
a priority in order to advance a preclinical model of rehabilitation that
can be applied to the TBI setting for implementation and assessment of
therapies. Hence, to mimic the clinic, the goal of this study was to test
the hypothesis that
delayed-and-abbreviated EE (i.e., rehabilitation)
would confer similar behavioral benefits as early-and-continuous EE.
Anesthetized male rats were subjected to a cortical impact (2.8mm
depth at 4m/s) or sham injury and randomly assigned to TBI
+
EE
(continuous), TBI
+
EE (rehabilitation; i.e., 3-day delayed, 6-hr day),
and respective sham controls. Motor function (beam-balance/beam-
walk) was assessed on post-operative days 1–5. Spatial learning/
memory (MWM) was evaluated on days 14–19. The data showed that
EE, regardless of timing, improved motor and cognitive function
compared to STD (
p
<
0.0001). Moreover, there were no differences
between TBI
+
EE (continuous) and TBI
+
EE (rehabilitation);
p
>
0.05.
These data demonstrate that delayed and abbreviated EE produces
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