UPFRONT-Study: Outpatient Follow-Up After Mild Traumatic Brain Injury
A recent study identified that 30 percent of mild traumatic brain injury (mTBI) patients experience unfavorable outcomes six months post-injury. The UPFRONT-study evaluated outpatient follow-up by health care providers in patients after mTBI. The study included both hospitalized and non-hospitalized patients.
Patients were recruited from 2013 to 2015 at trauma centers and were classified as mTBI patients under the European Federation of Neurological Societies (EFNS) guidelines. They were categorized as hospitalized or non-hospitalized (discharged directly from the emergency room). Of the 1151 patients included in the UPFRONT-study, 60 percent were admitted to the hospital; 48 percent were hospitalized for one day. The mean length of stay was 3.4 days.
Most studies on outcome after mTBI do not differentiate between hospitalized and non-hospitalized patients. But hospitalized patients are usually more severely injured and the guidelines provided to patients by healthcare providers differ as to follow-up care. For one thing, outpatient follow-up is recommended for hospitalized patients while follow-up care is recommended for non-hospitalized patients only when they have persistent complaints.
Two weeks post-injury, participants in the UPFRONT-study had an average of five post-traumatic complaints. There was no significant difference between hospitalized and non-hospitalized patients. The most common complaints were fatigue, headache, dizziness, increased need for sleep, and poor concentration.
Six months after injury, 46 percent of non-hospitalized patients reported more than one post-traumatic complaint, compared to 61 percent of the hospitalized patients. Eighty percent of hospitalized patients and 45 percent of non-hospitalized patients had consulted at least one specialist. Sixty percent of hospitalized patients and 25 percent of non-hospitalized patients had visited a neurologist. Seven percent of the non-hospitalized and 12 percent of the hospitalized patients had visited a psychiatrist or psychologist.
Six months after injury, the majority of patients showed complete or almost complete recovery. However, moderate disability occurred in 22 percent of patients and severe disability in 8 percent of patients.
The study concluded that two-thirds of all mTBI patients consult one or more specialists within six months after injury, with 30 percent having an unfavorable outcome. Twenty one percent of non-hospitalized patients experienced an unfavorable outcome, as contrasted with 34 percent of hospitalized patients.
Researchers reported that the follow-up rate with neurologists and unfavorable outcome in one in five of non-hospitalized patients were unexpected findings.
These findings highlight the importance of follow-up for all mTBI patients – regardless of whether patients are admitted to the hospital.