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Return to work after mild traumatic brain injury: association with positive CT and MRI findings
Antti Huovinen1, Ivan Marinkovic2, Harri Isokuortti2
1Neurology, University of Helsinki and Helsinki University Hospital (Mr Huovinen, Drs Marinkovic, Isokuortti and Melkas), Haartmaninkatu 4, P.O. Box 340, N00029, Helsinki, HUS, Finland. antti.huovinen@helsinki.fi.
Background:
Return to work (RTW) might be delayed in patients with complicated mild traumatic brain injury (MTBI), i.e., MTBI patients with associated traumatic intracranial lesions. However, the effect of different types of lesions on RTW has not studied before. We investigated whether traumatic intracranial lesions detected by CT and MRI are associated with return to work and post-concussion symptoms in patients with MTBI.
Methods:
We prospectively followed up 113 adult patients with MTBI that underwent a brain MRI within 3-17 days after injury. Return to work was assessed with one-day accuracy up to one year after injury. Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Glasgow Outcome Scale Extended (GOS-E) were conducted one month after injury. A Kaplan-Meier log-rank analysis was performed to analyze the differences in RTW.
Results:
Full RTW-% one year after injury was 98%. There were 38 patients with complicated MTBI, who had delayed median RTW compared to uncomplicated MTBI group (17 vs. 6 days), and more post-concussion symptoms (median RPQ 12.0 vs. 6.5). Further, RTW was more delayed in patients with multiple types of traumatic intracranial lesions visible in MRI (31 days, n = 19) and when lesions were detected in the primary CT (31 days, n = 24). There were no significant differences in GOS-E.
Conclusions:
The imaging results that were most clearly associated with delayed RTW were positive primary CT and multiple types of lesions in MRI. RTW-% of patients with MTBI was excellent and a single intracranial lesion does not seem to be a predictive factor of disability to work.
Insights
Return to work after mild traumatic brain injury (MTBI) is generally excellent. However, complicated MTBI with multiple intracranial lesions or positive CT scans significantly delays return to work and increases post-concussion symptoms.
Area of Science:
- Neuroscience
- Radiology
- Occupational Health
Background:
- Mild traumatic brain injury (MTBI) can lead to delayed return to work (RTW), particularly when complicated by intracranial lesions.
- The specific impact of different types of traumatic intracranial lesions on RTW and post-concussion symptoms remains understudied.
Purpose of the Study:
- To investigate the association between traumatic intracranial lesions detected by CT and MRI and RTW outcomes in MTBI patients.
- To examine the relationship between these lesions and the severity of post-concussion symptoms.
Main Methods:
- A prospective follow-up study of 113 adult MTBI patients who underwent brain MRI within 3-17 days post-injury.
- RTW was assessed for up to one year, with post-concussion symptoms measured using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and functional outcome using the Glasgow Outcome Scale Extended (GOS-E) at one month.
- Kaplan-Meier log-rank analysis was used to compare RTW rates between groups.
Main Results:
- Overall RTW at one year was 98%.
- Complicated MTBI patients experienced delayed median RTW (17 vs. 6 days) and more severe post-concussion symptoms (median RPQ 12.0 vs. 6.5) compared to uncomplicated cases.
- Multiple lesion types on MRI and positive findings on initial CT scans were associated with significantly delayed RTW (31 days).
Conclusions:
- Positive initial CT scans and multiple MRI-detected lesions are key indicators of delayed RTW in MTBI.
- While overall RTW is high, specific imaging findings can predict longer recovery periods.
- A single intracranial lesion does not appear to be a significant predictor of long-term work disability.
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