Preinjury employment status as a risk factor for symptomatology and disability in mild traumatic brain injury: A TRACK-TBI analysis

Article type: Research Article

Authors: Yue, John K.^{a; b} | Rick, Jonathan W.^{a; b} | Morrissey, Molly Rose^{a; b} | Taylor, Sabrina R.^{a; b} | Deng, Hansen^{a; b} | Suen, Catherine G.^{a; b} | Vassar, Mary J.^{a; b} | Cnossen, Maryse C.^c | Lingsma, Hester F.^c | Yuh, Esther L.^{b; c} | Mukherjee, Pratik^{b; c} | Gardner, Raquel C.^{d; e} | Valadka, Alex B.^f | Okonkwo, David O.^g | Cage, Tene A.^{a; b} | Manley, Geoffrey T.^{a; b; *} | TRACK-TBI Investigators¹

Affiliations: [a] Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA | [b] Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA | [c] Department of Radiology, University of California San Francisco, San Francisco, CA, USA | [d] Department of Neurology, University of California San Francisco, San Francisco, CA, USA | [e] Department of Neurology, Veterans Affairs Medical Center, San Francisco, CA, USA | [f] Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA | [g] Department of Neurological Surgery, University of Pittsburgh, PA, USA

Correspondence: [*] Address for correspondence: Geoffrey T. Manley, MD, PhD, Professor and Vice Chairman, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA. Tel.: +1 415 206 8300; Fax: +1 415 206 3948; E-mail: [email protected].

Note: [1] TRACK-TBI Investigators are listed in the Appendix in alphabetical order by last name.

Abstract: BACKGROUND:Preinjury employment status may contribute to disparity, injury risk, and recovery patterns following mild traumatic brain injury (MTBI). OBJECTIVE:To characterize associations between preinjury unemployment, prior comorbidities, and outcomes following MTBI. METHODS:MTBI patients from TRACK-TBI Pilot with complete six-month outcomes were extracted. Preinjury unemployment, comorbidities, injury factors, and intracranial pathology were considered. Multivariable regression was performed for employment and outcomes, correcting for demographic and injury factors. Mean-differences (B) and 95% CIs are reported. Statistical significance was assessed at p < 0.05. RESULTS:162 MTBI patients were aged 39.8±15.4-years and 24.6% -unemployed. Unemployed patients demonstrated increased psychiatric comorbidities (45.0% -vs.– 23.8%; p = 0.010), drug use (52.5% -vs.– 21.3%; p < 0.001), smoking (62.5% -vs.– 27.0%; p < 0.001), prior TBI (78.4% -vs.– 55.0%; p = 0.012), and lower education (15.0% -vs.– 45.1% college degree; p = 0.003). On multivariable analysis, unemployment associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended: B = – 0.50, 95% CI [– 0.88, – 0.11]), increased psychiatric disturbance (Brief Symptom Inventory-18: B = 6.22 [2.33, 10.10]), postconcussional symptoms (Rivermead Questionnaire: B = 4.91 [0.38, 9.44]), and post-traumatic stress disorder (PTSD Checklist-Civilian: B = 5.99 [0.76, 11.22]). No differences were observed for cognitive measures or satisfaction with life. CONCLUSIONS:Unemployed patients are at risk for preinjury psychosocial comorbidities, poorer six-month functional recovery and increased psychiatric/postconcussional/PTSD symptoms. Resource allocation and return precautions should be implemented to mitigate and/or prevent the decline of at-risk patients.

Keywords: Common data elements, comorbidities, mild traumatic brain injury, outcome measures, risk factors, unemployment

DOI: 10.3233/NRE-172375

Journal: NeuroRehabilitation, vol. 43, no. 2, pp. 169-182, 2018