Follow up rates and patient interest in clinical care after mild traumatic brain injury presenting to a level 1 trauma center: a TRACK-TBI prospective cohort study

Shawn R Eagle; Jason Barber; Nancy Temkin; Michael A McCrea; Joseph T Giacino; David O Okonkwo; Debbie Madhok; John K Yue; Jennifer M Zerbato; Geoffrey T Manley; Lindsay D Nelson; TRACK-TBI Investigators

doi:10.3389/fneur.2025.1558204

Follow up rates and patient interest in clinical care after mild traumatic brain injury presenting to a level 1 trauma center: a TRACK-TBI prospective cohort study

Front Neurol. 2025 Apr 2:16:1558204. doi: 10.3389/fneur.2025.1558204. eCollection 2025.

Collaborators

TRACK-TBI Investigators:
C Dirk Keene, Vijay Krishnamoorthy, Christine Mac Donald, Randall Merchant, Pratik Mukherjee, Laura B Ngwenya, Ava Puccio, Claudia Robertson, Richard B Rodgers, Sabrina R Taylor, Ross Zafonte

Affiliations

¹ Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
² Department of Neurological Surgery, University of Washington, Seattle, WA, United States.
³ Medical College of Wisconsin, Milwaukee, WI, United States.
⁴ Department of Physical Medicine and Rehabilitation, Harvard University, Cambridge, MA, United States.
⁵ Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.

Abstract

Study objective: To evaluate the rates of clinical follow-up and patient interest in clinical follow-up within the first year of traumatic brain injury (TBI) with presenting Glasgow Coma Scale (GCS) score between 13 and 15.

Methods: This is a secondary analysis of a prospective cohort study which enrolled patients with TBI first evaluated at a 1 of 23 level 1 trauma centers (n = 1,916). At 2 weeks and 3 months, the participants were asked "have you seen any healthcare provider for your TBI?" and "if so, did it help?." Participants also completed the Rivermead Post-Concussion Questionnaire (RPQ), Quality of Life after Brain Injury- Overall Scale (QOLIBRI-OS), and Glasgow Outcome Scale Extended for TBI (GOSE-TBI) at 2 weeks, 3-, 6-, and 12-months. Persistent symptoms were defined as 3+ symptoms worse than pre-injury levels. QOLIBRI-OS≤51 was defined as lower quality of life. GOSE<8 was defined as incomplete recovery.

Results: By 2 weeks, 43% of participants had followed up with a clinical provider; cumulative follow-up within the first year was 63%. Overall, 61% of participants interested in clinical follow-up care reported receiving clinical follow-up care. Participants who received follow-up care reported that it helped at an 86% rate. Of those not interested in follow-up care, 42% reported receiving clinical follow-up care and 86% of those receiving care reported that it helped. Approximately 44% of participants who reported "I did not think I need follow-up" at 2 weeks had incomplete recovery (GOSE<8), 40% had persistent symptoms, and 19% had lower quality of life at 12-months post-injury.

Conclusion: Participants not interested in follow-up care had high rates of poor functional recovery, persistent symptoms and lower quality-of-life at 12 months following traumatic brain injury with GCS 13-15. Education and provider emphasis on the importance of clinical follow-up after hospital discharge with TBI need to be enhanced. Prioritizing timely clinical follow-up for adult patients with TBI with GCS 13 to 15 is critical for improving rates of long-term recovery in this population.

Keywords: GFAP; blood biomarkers; clinical follow up; concussion; emergency department; mTBI.

Grants and funding

The author(s) declare that financial support was received for the research and/or publication of this article. This study was funded by the National Institutes of Health (award number: 1U01NS086090-01).