Outcomes after Traumatic Brain Injury with and Without Computed Tomography

Area of Science:

• Neuroscience
• Trauma Surgery
• Public Health

Background:

• Improved understanding of traumatic brain injury (TBI) often relies on cohort studies including patients requiring computed tomography (CT) scans.
• Using CT head as an inclusion criterion may lead to an overestimation of poor outcomes in patients with mild TBI (Glasgow Coma Scale [GCS] 13-15).

Purpose of the Study:

• To compare 6-month post-TBI outcomes in adults with mild TBI (GCS 13-15) who underwent a head CT scan versus those who did not.
• To assess if requiring a head CT scan for study entry introduces selection bias in TBI outcome research.

Main Methods:

• Secondary analysis of a clinical trial involving adults with mild TBI (GCS 13-15) in Vancouver, Canada.
• Participants (n=493) were analyzed based on whether they received a head CT scan (negative findings) or no CT scan.
• Outcomes assessed at 6 months included Glasgow Outcome Scale Extended (GOSE), Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Patient Health Questionnaire (PHQ)-9, and Generalized Anxiety Disorder (GAD)-7.

Main Results:

• Over half (55%) of participants received a head CT scan.
• At 6 months, functional limitations (GOSE), severe post-concussion symptoms (RPQ), depression (PHQ-9), and anxiety (GAD-7) were comparable between the CT and no-CT groups.
• Adjusted regression analysis showed slightly higher odds of worse functioning for the CT group (OR 1.4, 95% CI 1.0-2.0), but similar odds for other outcomes.

Conclusions:

• Adults with mild TBI (GCS 13-15) who received a head CT scan generally have comparable outcomes to those who did not.
• Excluding patients based on CT findings may not introduce significant selection bias in outcome research for mild TBI.