Loss of Consciousness, Confusion Following Mild TBI May Predict Delayed Recovery

Patients who lose consciousness and/or become dazed and confused following mild traumatic brain injury (mTBI) are less likely to fully recover within one month compared with mTBI patients without such symptoms, reports a study in the Journal of Neuropsychiatry and Clinical Neurosciences. Patients who experienced both loss of consciousness and a confused state had the highest risk of incomplete recovery one month after sustaining the injury. Among patients who had only one of these symptoms, loss of consciousness was a stronger indicator of incomplete recovery than a confused state.

These findings point to “additional risk factors for incomplete recovery post-mTBI, which will help identify patients who are in need of early psychosocial, rehabilitation, and psychiatric interventions,” wrote Durga Roy, M.D., of Johns Hopkins University School of Medicine and colleagues.

The findings come from an analysis of 407 adults who were admitted to either the Johns Hopkins Bayview Medical Center or Johns Hopkins Hospital emergency room for an mTBI due to blunt head trauma. Eighty-three of these adults lost consciousness (defined as complete or near-complete lack of responsiveness to people and other stimuli at the time of injury), 64 experienced an altered mental state (defined as being dazed, confused, or disoriented within 24 hours of injury), 127 experienced both, and 133 experienced neither. Functional recovery—which reflects how quickly and fully a patient resumes daily life activities, such as employment and social activities—was assessed via telephone or in-person interviews one, three, and six months after the head injury, using the Glasgow Outcome Scale–Extended (GOSE).

After one month, the odds of an incomplete recovery were 45% for patients who did not lose consciousness or have an altered mental state, 55% for patients who lost consciousness, 62% for patients with an altered mental state, and 70% for patients with both loss of consciousness and altered mental state. After adjusting for other clinical variables, Roy and colleagues calculated that loss of consciousness was associated with 2.17 times increased risk of incomplete functional recovery while an altered mental state was associated with 1.80 times increased risk of incomplete recovery after one month. Loss of consciousness also increased the risk of incomplete recovery at three months (though an altered mental state did not), and neither symptom increased the risk of incomplete recovery at six months.

For related information, see the Psychiatric News article “FDA Clears the Way for First Blood Test to Evaluate Head Injuries.”

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