Symptom burden in the first four years following hospitalization after mild traumatic brain injury

1) Describe clinically significant symptoms over 4 years following hospitalization after mild traumatic brain injury (mTBI); 2) examine quality of life (QoL), social participation, and healthcare service use in relation to symptom burden.

Longitudinal cohort study in which 142 adults (ages 18-65) hospitalized following mTBI were assessed 4, 8, 12, 24, 36, and 48 months post-injury. Questionnaires and interviews evaluated fatigue, insomnia, cognitive complaints, anxiety, depression, headaches, dizziness, QoL, social participation, and healthcare service use for mTBI symptoms. The number of clinically significant symptoms (based on validated cutoff scores) was totaled for each participant; QoL, social participation, and healthcare services were examined in relation to the number of symptoms.

At each timepoint, ≥45% of the participants experienced 3+ symptoms and ≥15% experienced 5+. The mean number of symptoms was similar over time (2.48-2.79; p = 0.32). The presence of 3+ symptoms was associated with poor QoL and social participation, including lower rates of return-to-work. Healthcare service use was not universal, even among individuals with 5+ symptoms.

Clinicians should be alert to the long-term presence of multiple symptoms following hospitalization after mTBI, as these affect a significant proportion of individuals and are associated with poorer outcomes.