Penetrating, Blast Dikmen et al., 1995 Prospective
cohort
436 adults, head-injured patients recruited at time of injury in one of three prospective longitudinal studies: behavioral outcome of head injury, patient characteristics and head-injury outcome, Dilantin prophylaxis of posttraumatic seizures
121 general TCs enrolled as part of patient-
characteristics study
Minimal severity criteria: any period of LOC, PTA for at least 1 h, or other objective evidence of head trauma
Head-injury severity assessed with GCS, number of nonreactive pupils, mass lesions requiring craniotomy, TFC
Coma from <1 h to more than 4 weeks
Subjects assessed 1 mo, 1 year after injury
Neuropsychologic tests included Halstead Reitan Neuropsycho- logical Test Battery; motor function assessed with finger- tapping, name- writing for dominant, nondominant hands; attention, concentration, flexibility, quickness measured with Seashore Rhythm Test, TMT A and TMT B, Stroop Color and Word Test Parts 1 and 2; memory evaluated with WMS, WMS- LM, WMS-VR, SR; verbal skills measured with
At 1 year after injury: head- injured
significantly worse than controls (p <
0.01) on
neuropsychologic tests except difference on Category Test (p < 0.05)
Nonsignificant differences on two memory measures.
Severely head- injured (TFC 29 days or greater) had significant impairments on all measures (p <
0.001) except WMS-LM (p <
0.01), WMS-VR (p < 0.05)
Clear dose–
response relationship between length of coma (TFC), level
Controls matched on age, sex, education
Results represent weighted averages that adjust for differences between studies in inclusion criteria
Study subjects included 85% of 514 subjects recruited from three
longitudinal studies
Blast
W AIS VIQ;
performance skills measured with W AIS PIQ, Tactual
Performance Test; reasoning measured with Category Test;
overall performance measured with Halstead
Impairment Index
of performance on neuropsychologic measures; for example, median II for TC = 0.1; TFC
< 1 h = 0.1, 1–24 h
= 0.3, 25 h–6 days
= 0.4, 7–13 days = 0.4, 14–28 days = 0.7, >29 days = 1.0
Dikmen, 1986 Prospective cohort
20 hospitalized subjects with mild head injury; 19 uninjured friend controls
19 of 20 seen at 1 year
Mild; subjects met following criteria: coma not over 1 h or, if no coma, PTA of at least 1 h;
GCS ≥12 on admission; no clinical evidence of cortical or brainstem contusion
Motor, psychomotor skills (finger- tapping speed);
attention, flexibility, quickness (Speech Sounds Perception, Seashore Rhythm, TMT A, TMT B);
memory and learning (WMS, SR); reasoning (Category Test);
health status in terms of sickness (Sickness Impact Profile);
1 mo after TBI, mild
neuropsychologic effects found, none significantly different; at 1 year after TBI, similar post-TBI
symptoms reported in TBI, non-TBI subjects
Matched on age, education, sex
Exclusion criteria:
subjects with prior head injury, alcoholism, cerebral disease, mental retardation, significant psychiatric disorder 15–60 years old
Healthy friend controls may not control for general effects of trauma Small sample
Blast
symptoms frequently reported as part of TBI (Head Injury Symptom Checklist);
resumption of major activities, including work, school,
homemaking (Function Status Index)
Dikmen, 1987 Prospective cohort
102 people with closed head injury admitted into Harborview Medical Center, Seattle; 102 friend controls
97 of 102 head- injured, 88 of 102 controls evaluated at 1 year after injury
Mild, moderate, severe
Subjects met following criteria: LOC or PTA over 1 h or evidence of cerebral trauma
30% GCS 3-8, 12% GCS 9-11, 59% GCS >12
23% PTA < 24 h, 25% PTA 1–6 days, 20% PTA 7–13 days, 32%
PTA >14 days
Memory (WMS, SRP)
At 1 mo after TBI, head-injured group performed
significantly worse on both memory tests (p < 0.001);
at 1 year after TBI, most subscales still show significant impairment
Memory performance a function of head- injury severity, length of coma at 1 mo; weaker relationship at 1 year after TBI
Matched on age, education, race, sex
Exclusion criteria:
prior CNS injury, significant neuropsychiatric difficulties 15–60 years old
Blast 77% moving- vehicle accidents, 10%
falls, 8% fights or assaults, 5%
other Tate et al., 1991 Cohort Consecutive series
of first 100 admissions into adult head-injury rehabilitation unit
Followed average of 6.3 years after trauma
Eligible: 66 males, 21 females, sibling controls
Severe, blunt TBI: sustained open head injury, initial closed head injury later required neurosurgery
Head-injured group sustained severe injuries:
98% had PTA over 1 week, 74% over 1 mo
Subjects examined by trained clinical neuropsychologist
Neuropsychologic impairment evaluated with MMS, Incomplete Letters,
ideomotor praxis tasks, ROCF, W AIS-R Digit Span and V ocabulary subtests, Schonell Reading Test, TMT, SR, AM, Corsi test of recency memory, WCST, TT, Word Fluency Test of Thurstone and Thurstone, DF, BCT
70% of head- injured showed impairments:
56.5% of head- injured had disorders of learning, memory vs 5% in sibling control group;
16.5% of head- injured had disturbances in basic
neurocognitive skills vs 2.5% in sibling control group; 34.1% of head-injured had slowness in information processing vs 2.5%
in sibling control group; 40% of head-injured had posttraumatic personality change vs 7.5% in sibling
Controls matched on age, sex, education, SES
Australian rehabilitation population
82 of 100 subjects completed neuropsychologic tests
15–45 years old Crude ORs
Blast
control group Lannoo et al., 1998 Cohort 85 patients
consecutively admitted into the ICU of University Hospital of Gent in September 1993–February 1996
32 TCs (traumatic injuries of parts of body other than head) admitted into ICU during same study period
Moderate to severe TBI (GCS score 3–
12)
Administered neuropsychologic test battery at 6 mo after injury, including tests of:
attention, information processing; visual reaction time;
memory, learning; verbal fluency; mental flexibility
MANOV A on neuropsychologic test battery indicated significant
difference between groups (p < 0.05);
univariate analyses showed significant differences (p <
0.05) on almost all tests, with TBI group performing worst
Inclusion criteria for patients and controls:
ages 15–65 years, no history of CNS disease or mental retardation
Heitger et al., 2006 Prospective cohort
37 patients with mild head injury, 37 controls;
patients recruited from ED of Christchurch Hospital, New Zealand; controls recruited from database of interested students
Mild Neurocognitive
testing: P ASA T, TMT A and TMT B, W ASI
At 12 mo, no neurocognitive deficits remained
Marginal group differences on CVL T total standard score
Controls matched on age, sex, education
Exclusion criteria included alcohol or drug use; CNS disorder; psychiatric conditions; structural brain damage or hematoma on CT scan; oculomotor or somatomotor deficits;
strabismus, poor visual acuity, skull fracture, or history of prior TBI
