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Population-Based, Inception Cohort Study of the Incidence, Course, and Prognosis of Mild Traumatic Brain Injury After Motor Vehicle Collisions

  • J. David Cassidy
    Correspondence
    Corresponding author J. David Cassidy, PhD, DrMedSc, IOB, University of Southern Denmark, Campusvej 55, Odense M, 5230 Denmark.
    Affiliations
    Faculty of Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Faculty of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Eleanor Boyle
    Affiliations
    Faculty of Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Linda J. Carroll
    Affiliations
    School of Public Health and Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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      Abstract

      Objective

      To determine the incidence, course, and prognosis of adult mild traumatic brain injury (MTBI) caused by motor vehicle collisions.

      Design

      Prospective, population-based, inception cohort study.

      Setting

      The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.

      Participants

      All adults (N=1716) incurring an MTBI in a motor vehicle collision between November 1997 and December 1999 in Saskatchewan.

      Interventions

      Not applicable.

      Main Outcome Measures

      Age- and sex-stratified incidence rates, time to self-reported recovery, and prognostic factors over a 1-year follow-up.

      Results

      Of 7170 adults injured in a motor vehicle collision over the 2-year inception period, 1716 (24%) met our cohort definition of MTBI. There were more women affected (53%), and MTBI was most common in the 18- to 23-year-old group. Most were not hospitalized (73%), but 28% reported loss of consciousness and 23% reported posttraumatic amnesia. The annual incidence of MTBI per 100,000 adults was 106.1 (95% confidence interval [CI], 98.9–113.6) in the first year and 118.3 (95% CI, 110.8–126.3) in the second year of the study. The 1-year follow-up rate was 84%. The median time to recovery was 100 days (95% CI, 97–103), and about 23% reported not having recovered by 1 year. Factors associated with delayed recovery included being older than 50 years, having less than a high school education, having poor expectations for recovery, having depressive symptoms, having arm numbness, having hearing problems, having headaches, having low back pain, and having thoracic back pain. Loss of consciousness and posttraumatic amnesia were not associated with recovery.

      Conclusions

      MTBI affects almost a quarter of persons reporting an injury after a traffic collision. The median time to recovery is 100 days, but 23% have still not recovered by 1 year. A mix of biopsychosocial factors is associated with recovery, including a strong effect of poor expectations for recovery.

      Keywords

      List of abbreviations:

      LOC (loss of consciousness), MTBI (mild traumatic brain injury), PTA (posttraumatic amnesia), SGI (Saskatchewan Government Insurance)
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