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Long-term outcomes of major trauma patients with concussion

  • Biswadev Mitra
    Correspondence
    Corresponding author at: Emergency & Trauma Centre, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Victoria, Australia

    Emergency & Trauma Centre, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia

    National Trauma Research Institute, The Alfred Hospital, Victoria, Australia
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  • Ben Beck
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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  • Joanna F. Dipnall
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Victoria, Australia

    Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
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  • Jennie Ponsford
    Affiliations
    School of Psychological Sciences, Monash University, Victoria, Australia

    Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Victoria, Australia
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  • Belinda Gabbe
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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  • Peter A. Cameron
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Victoria, Australia

    Emergency & Trauma Centre, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia

    National Trauma Research Institute, The Alfred Hospital, Victoria, Australia
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      Highlights

      • Concussion is diagnosed commonly in the setting of major trauma to other body regions.
      • There was no association of concussion with long-term adverse outcomes, measured using the Glasgow Outcome Scale-Extended.
      • There was no association of concussion with long term anxiety and/or depression.

      Abstract

      Introduction

      Concussion may be sustained in the setting of injuries to multiple body regions and persistent effects of concussion may impact recovery. This project aimed to evaluate the association between concussion and 6-month and 12-month functional outcomes in survivors after major trauma.

      Methods

      This was a registry-based cohort study that included adult patients with major trauma who presented to hospital between 01 Jan 2008 and 31 Dec 2017 and survived to hospital discharge. We excluded patients presenting with a Glasgow Coma Scale score <13 and those diagnosed with other intracranial injuries. Additionally, from the non-concussed group, patients with fractured skull and/or face were excluded, with the assumption that such patients may have had undiagnosed concussion. A good recovery was considered for Glasgow Outcome Scale-Extended (GOS-E) scores of 7 or 8. In addition, we assessed for patient reported anxiety and/or depression measured using the 3-level EuroQol 5 dimensions questionnaire. A modified mixed effects Poisson models with random intercepts for participant was used to assess the association between concussion and outcome.

      Results

      There were 28,161 eligible patients and 12,822 met inclusion criteria. Concussion was diagnosed in 1860 patients (14.5%; 95%CI: 13.9–15.1). There was no association between concussion and good recovery at 12 months (aRR 1.05 (95%CI: 0.99–1.11). There was no association between concussion and anxiety and/or depression at 12 months (aRR 1.03; 95%CI: 0.99–1.07).

      Conclusions

      Concussion was sustained among 14.5% of included patients in the setting of major trauma but not associated with longer-term adverse outcomes using GOS-E. Concussed patients did not report differential rates of anxiety and/or depression.

      Keywords

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