Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Feb;66(2):207–213. doi: 10.1136/jnnp.66.2.207

One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work

J van der Naalt 1, A H van Zomeren 1, W Sluiter 1, J Minderhoud 1
PMCID: PMC1736194  PMID: 10071101

Abstract

OBJECTIVES—To determine the prognostic value of characteristics of acute injury and duration of post-traumatic amnesia (PTA) for long term outcome in patients with mild to moderate head injury in terms of complaints and return to work.
METHODS—Patients with a Glasgow coma score (GCS) on admission of 9-14 were included. Post-traumatic amnesia was assessed prospectively. Follow up was performed at 1, 3, 6, and 12 months after injury. Outcome was determined by the Glasgow outcome scale (GOS) 1 year after injury and compared with a more detailed outcome scale (DOS) comprising cognitive and neurobehavioural aspects.
RESULTS—Sixty seven patients were included, mean age 33.2 (SD 14.7) years and mean PTA 7.8 (SD 7.3) days. One year after injury, 73% of patients had resumed previous work although most (84%) still reported complaints. The most frequent complaints were headache (32%), irritability (34%), forgetfulness and poor concentration (42%), and fatigue (45%). According to the GOS good recovery (82%) or moderate disability (18%) was seen. Application of the DOS showed more cognitive (40%) and behavioural problems (48%), interfering with return to work. Correlation between the GOS and DOS was high (r=0.87, p<0.01). Outcome correlated with duration of PTA (r=−0.46) but not significantly with GCS on admission (r=0.19). In multiple regression analysis, PTA and the number of complaints 3 months after injury explained 49% of variance on outcome as assessed with the GOS, and 60% with the DOS.
CONCLUSIONS—In mild to moderate head injury outcome is determined by duration of PTA and not by GCS on admission. Most patients return to work despite having complaints. The application of a more detailed outcome scale will increase accuracy in predicting outcome in this category of patients with head injury.



Full Text

The Full Text of this article is available as a PDF (134.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams J. H., Graham D. I., Murray L. S., Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol. 1982 Dec;12(6):557–563. doi: 10.1002/ana.410120610. [DOI] [PubMed] [Google Scholar]
  2. Alexander M. P. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995 Jul;45(7):1253–1260. doi: 10.1212/wnl.45.7.1253. [DOI] [PubMed] [Google Scholar]
  3. Anderson S. I., Housley A. M., Jones P. A., Slattery J., Miller J. D. Glasgow Outcome Scale: an inter-rater reliability study. Brain Inj. 1993 Jul-Aug;7(4):309–317. doi: 10.3109/02699059309034957. [DOI] [PubMed] [Google Scholar]
  4. Barth J. T., Macciocchi S. N., Giordani B., Rimel R., Jane J. A., Boll T. J. Neuropsychological sequelae of minor head injury. Neurosurgery. 1983 Nov;13(5):529–533. doi: 10.1227/00006123-198311000-00008. [DOI] [PubMed] [Google Scholar]
  5. Bishara S. N., Partridge F. M., Godfrey H. P., Knight R. G. Post-traumatic amnesia and Glasgow Coma Scale related to outcome in survivors in a consecutive series of patients with severe closed-head injury. Brain Inj. 1992 Jul-Aug;6(4):373–380. doi: 10.3109/02699059209034952. [DOI] [PubMed] [Google Scholar]
  6. Brooks D. N., Aughton M. E., Bond M. R., Jones P., Rizvi S. Cognitive sequelae in relationship to early indices of severity of brain damage after severe blunt head injury. J Neurol Neurosurg Psychiatry. 1980 Jun;43(6):529–534. doi: 10.1136/jnnp.43.6.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Brooks D. N., Hosie J., Bond M. R., Jennett B., Aughton M. Cognitive sequelae of severe head injury in relation to the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1986 May;49(5):549–553. doi: 10.1136/jnnp.49.5.549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bullock R., Maxwell W. L., Graham D. I., Teasdale G. M., Adams J. H. Glial swelling following human cerebral contusion: an ultrastructural study. J Neurol Neurosurg Psychiatry. 1991 May;54(5):427–434. doi: 10.1136/jnnp.54.5.427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Choi S. C., Muizelaar J. P., Barnes T. Y., Marmarou A., Brooks D. M., Young H. F. Prediction tree for severely head-injured patients. J Neurosurg. 1991 Aug;75(2):251–255. doi: 10.3171/jns.1991.75.2.0251. [DOI] [PubMed] [Google Scholar]
  10. Dacey R., Dikmen S., Temkin N., McLean A., Armsden G., Winn H. R. Relative effects of brain and non-brain injuries on neuropsychological and psychosocial outcome. J Trauma. 1991 Feb;31(2):217–222. [PubMed] [Google Scholar]
  11. Dikmen S., McLean A., Jr, Temkin N. R., Wyler A. R. Neuropsychologic outcome at one-month postinjury. Arch Phys Med Rehabil. 1986 Aug;67(8):507–513. [PubMed] [Google Scholar]
  12. Dikmen S., McLean A., Temkin N. Neuropsychological and psychosocial consequences of minor head injury. J Neurol Neurosurg Psychiatry. 1986 Nov;49(11):1227–1232. doi: 10.1136/jnnp.49.11.1227. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Dikmen S., Temkin N., McLean A., Wyler A., Machamer J. Memory and head injury severity. J Neurol Neurosurg Psychiatry. 1987 Dec;50(12):1613–1618. doi: 10.1136/jnnp.50.12.1613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ellenberg J. H., Levin H. S., Saydjari C. Posttraumatic Amnesia as a predictor of outcome after severe closed head injury. Prospective assessment. Arch Neurol. 1996 Aug;53(8):782–791. doi: 10.1001/archneur.1996.00550080104018. [DOI] [PubMed] [Google Scholar]
  15. Englander J., Hall K., Stimpson T., Chaffin S. Mild traumatic brain injury in an insured population: subjective complaints and return to employment. Brain Inj. 1992 Mar-Apr;6(2):161–166. doi: 10.3109/02699059209029654. [DOI] [PubMed] [Google Scholar]
  16. Esselman P. C., Uomoto J. M. Classification of the spectrum of mild traumatic brain injury. Brain Inj. 1995 May-Jun;9(4):417–424. doi: 10.3109/02699059509005782. [DOI] [PubMed] [Google Scholar]
  17. Gennarelli T. A., Thibault L. E., Adams J. H., Graham D. I., Thompson C. J., Marcincin R. P. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol. 1982 Dec;12(6):564–574. doi: 10.1002/ana.410120611. [DOI] [PubMed] [Google Scholar]
  18. Gentilini M., Nichelli P., Schoenhuber R., Bortolotti P., Tonelli L., Falasca A., Merli G. A. Neuropsychological evaluation of mild head injury. J Neurol Neurosurg Psychiatry. 1985 Feb;48(2):137–140. doi: 10.1136/jnnp.48.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Gronwall D., Wrightson P. Cumulative effect of concussion. Lancet. 1975 Nov 22;2(7943):995–997. doi: 10.1016/s0140-6736(75)90288-3. [DOI] [PubMed] [Google Scholar]
  20. Hugenholtz H., Stuss D. T., Stethem L. L., Richard M. T. How long does it take to recover from a mild concussion? Neurosurgery. 1988 May;22(5):853–858. [PubMed] [Google Scholar]
  21. Jane J. A., Steward O., Gennarelli T. Axonal degeneration induced by experimental noninvasive minor head injury. J Neurosurg. 1985 Jan;62(1):96–100. doi: 10.3171/jns.1985.62.1.0096. [DOI] [PubMed] [Google Scholar]
  22. Jennett B., Bond M. Assessment of outcome after severe brain damage. Lancet. 1975 Mar 1;1(7905):480–484. doi: 10.1016/s0140-6736(75)92830-5. [DOI] [PubMed] [Google Scholar]
  23. Jennett B., Snoek J., Bond M. R., Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981 Apr;44(4):285–293. doi: 10.1136/jnnp.44.4.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Karzmark P. Prediction of long-term cognitive outcome of brain injury with neuropsychological, severity of injury, and demographic data. Brain Inj. 1992 May-Jun;6(3):213–217. doi: 10.3109/02699059209029662. [DOI] [PubMed] [Google Scholar]
  25. Katz D. I., Alexander M. P. Traumatic brain injury. Predicting course of recovery and outcome for patients admitted to rehabilitation. Arch Neurol. 1994 Jul;51(7):661–670. doi: 10.1001/archneur.1994.00540190041013. [DOI] [PubMed] [Google Scholar]
  26. Kelly R. The post-traumatic syndrome: an iatrogenic disease. Forensic Sci. 1975 Aug-Oct;6(1-2):17–24. doi: 10.1016/0300-9432(75)90219-8. [DOI] [PubMed] [Google Scholar]
  27. Kibby M. Y., Long C. J. Minor head injury: attempts at clarifying the confusion. Brain Inj. 1996 Mar;10(3):159–186. doi: 10.1080/026990596124494. [DOI] [PubMed] [Google Scholar]
  28. King N. S., Crawford S., Wenden F. J., Moss N. E., Wade D. T., Caldwell F. E. Measurement of post-traumatic amnesia: how reliable is it? J Neurol Neurosurg Psychiatry. 1997 Jan;62(1):38–42. doi: 10.1136/jnnp.62.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. King N. S., Crawford S., Wenden F. J., Moss N. E., Wade D. T. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. 1995 Sep;242(9):587–592. doi: 10.1007/BF00868811. [DOI] [PubMed] [Google Scholar]
  30. Levin H. S., Mattis S., Ruff R. M., Eisenberg H. M., Marshall L. F., Tabaddor K., High W. M., Jr, Frankowski R. F. Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg. 1987 Feb;66(2):234–243. doi: 10.3171/jns.1987.66.2.0234. [DOI] [PubMed] [Google Scholar]
  31. Lidvall H. F., Linderoth B., Norlin B. Causes of the post-concussional syndrome. Acta Neurol Scand Suppl. 1974;56:3–144. [PubMed] [Google Scholar]
  32. MILLER H. Accident neurosis. Br Med J. 1961 Apr 8;1(5231):992–998. doi: 10.1136/bmj.1.5231.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. McLean A., Jr, Dikmen S. S., Temkin N. R. Psychosocial recovery after head injury. Arch Phys Med Rehabil. 1993 Oct;74(10):1041–1046. doi: 10.1016/0003-9993(93)90059-j. [DOI] [PubMed] [Google Scholar]
  34. McLean A., Jr, Dikmen S., Temkin N., Wyler A. R., Gale J. L. Psychosocial functioning at 1 month after head injury. Neurosurgery. 1984 Apr;14(4):393–399. doi: 10.1227/00006123-198404000-00001. [DOI] [PubMed] [Google Scholar]
  35. Middleboe T., Andersen H. S., Birket-Smith M., Friis M. L. Minor head injury: impact on general health after 1 year. A prospective follow-up study. Acta Neurol Scand. 1992 Jan;85(1):5–9. [PubMed] [Google Scholar]
  36. Minderhoud J. M., Boelens M. E., Huizenga J., Saan R. J. Treatment of minor head injuries. Clin Neurol Neurosurg. 1980;82(2):127–140. doi: 10.1016/0303-8467(80)90007-4. [DOI] [PubMed] [Google Scholar]
  37. Oppenheimer D. R. Microscopic lesions in the brain following head injury. J Neurol Neurosurg Psychiatry. 1968 Aug;31(4):299–306. doi: 10.1136/jnnp.31.4.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Povlishock J. T., Becker D. P., Cheng C. L., Vaughan G. W. Axonal change in minor head injury. J Neuropathol Exp Neurol. 1983 May;42(3):225–242. doi: 10.1097/00005072-198305000-00002. [DOI] [PubMed] [Google Scholar]
  39. Rimel R. W., Giordani B., Barth J. T., Boll T. J., Jane J. A. Disability caused by minor head injury. Neurosurgery. 1981 Sep;9(3):221–228. [PubMed] [Google Scholar]
  40. Rimel R. W., Giordani B., Barth J. T., Jane J. A. Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery. 1982 Sep;11(3):344–351. doi: 10.1227/00006123-198209000-00002. [DOI] [PubMed] [Google Scholar]
  41. Rutherford W. H. Sequelae of concussion caused by minor head injuries. Lancet. 1977 Jan 1;1(8001):1–4. doi: 10.1016/s0140-6736(77)91649-x. [DOI] [PubMed] [Google Scholar]
  42. Stambrook M., Moore A. D., Peters L. C., Deviaene C., Hawryluk G. A. Effects of mild, moderate and severe closed head injury on long-term vocational status. Brain Inj. 1990 Apr-Jun;4(2):183–190. doi: 10.3109/02699059009026164. [DOI] [PubMed] [Google Scholar]
  43. Tabaddor K., Mattis S., Zazula T. Cognitive sequelae and recovery course after moderate and severe head injury. Neurosurgery. 1984 Jun;14(6):701–708. doi: 10.1227/00006123-198406000-00010. [DOI] [PubMed] [Google Scholar]
  44. Williams D. H., Levin H. S., Eisenberg H. M. Mild head injury classification. Neurosurgery. 1990 Sep;27(3):422–428. doi: 10.1097/00006123-199009000-00014. [DOI] [PubMed] [Google Scholar]
  45. Wrightson P., Gronwall D. Time off work and symptoms after minor head injury. Injury. 1981 May;12(6):445–454. doi: 10.1016/0020-1383(81)90161-3. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES