Traumatic Brain Injuries Require More Than 2 Weeks for Recovery
MARCH 11, 2020
Stephen Kara, MBChB, FRNZCGP
A team, Stephen Kara, MBChB, FRNZCGP, Axis Sports Medicine Specialists, described the clinical recovery time and factors that could impact recovery following a sports-related mild traumatic brain injury (SR-mTBI).
The prospective cohort study was conducted at the New Zealand Sports Concussion Clinic with 594 patients within 14 days of a sports-related mild traumatic brain injury or a concussion over a two-year period.
The investigators measured clinical recovery as the number of days following the injury.
Each participant was assessed and managed using a standardized protocol that consists of relative rest followed by controlled cognitive and physical loading.
The investigators reassessed each patient 14 days following the injury with initiation of an active rehabilitation program that consisted of a subsymptom threshold program and if required a cervicovestibular rehabilitation program for participants who remained symptomatic.
Every 2 weeks the patients were assessed until clinical recovery.
The patients were grouped into 3 age cohorts: children under the age of 12, adolescents between 13-18 years old, and adults older than 19.
Within 14 days of injury, 45% of participants showed clinical recovery. However, 77% of participants achieved clinical recovery by 4 weeks after injury and 96% of individuals showed clinical recovery by week 8.
There was also no significant difference in recovery time between the different age groups, while prolonged recovery was more common in females (P = 0.001), participants with “concussion modifiers” (P = 0.001), and patients with increased time between injury and the initial appointment (P = 0.003).
“This study challenges current perceptions that most people with a SR-mTBI (concussion) recover within 10 to 14 days and that age is a determinant of recovery rate,” the authors wrote. “Active rehabilitation results in high recovery rates after SR-mTBI.”
Recently, it has come to light that the overwhelming majority of traumatic brain injury studies involving veterans in the US are overwhelmingly male.
Currently, the overwhelming majority of studies focusing on mild traumatic brain injuries in active military and veteran populations detail the psychological, neurological, and functional outcomes of males. Approximately 95% of these cohort studies focus on males, suggesting that current research could misrepresent female symptoms and outcomes.
The investigators matched 49 male and female pairs based on the mechanism of their injury, time from injury to assessment, and the patient’s age at assessment.
Several different statistical measures were used in the study to assess the data, including t-tests, chi-square, correlations, and post hoc linear regression.
The analysis showed 4 significant (P <.05) sex differences in living situation, marital status, vocation, and branch of service.
Only the Neurobehavioral Symptom Inventory (NSI) composite cognitive domain factor showed significantly between females (mean: 10.26) and males (mean: 7.58).
The investigators confirmed a significant effect of sex for cognitive composite (P = .002) linear regression.
“We conclude that sex has a moderate effect on mTBI post-concussive symptom presentation,” the authors wrote. “The significant sex difference in the NSI cognitive domain characterizes sex-related symptomology profiles providers can focus on for better rehabilitation management.”
The patient population in the New Zealand study was 77% male.
The study, “Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury,” was published online in the Clinical Journal of Sport Medicine.