Long Term Outcome Following Mild Traumatic Brain Injury in Moroccan Patients
Foutassi M, Hajjioui A, El Ouahabi A, Benmassoud H, Hajjaj-Hassouni N, El Khamlichi A. Clin Neurol Neurosurg. 2011 July; 133: 716-720.
Mild traumatic brain injury (MTBI) is a common neurologic injury and is commonly seen in athletics which involve contact. Evidence does exist that some residual symptoms (headaches, forgetfulness, etc.) can still persist long term. Therefore, Foutrassi and colleagues attempted to characterize post-concussion symptoms in a cohort of Moroccan patients with MTBIs to assess the relationship between chronic post-concussion symptoms (PCS) and aspects of the patient’s social and professional lives. Patients were retrospectively recruited from a teaching hospital in Morocco. Patients were included if they had (1) one or more of the following: confusion or disorientation, loss of consciousness for 30 minutes or less, post traumatic amnesia for less than 24 hours and or transient neurological abnormalities (seizures) and (2) Glasgow Coma Scale score of 13-15 after 30 minutes post-injury. After examination of the inclusion/exclusion criteria a total of 42 patients were included in the study (50% injured during automobile accidents). The investigators used The Problem Checklist from the New York Head Injury Family Interview to assess PCS and a visual analog scale to assess the patient’s quality of life (estimated prior to injury and current status) between 12 and 15 months following injury. Both instruments were administered orally to the patients. 54.8% of patients were found to have PCS at one year post injury. The most commonly reported PCS by patients were headaches (76.2%), forgetfulness (90.5%), hyperacusis (sensitivity to sound) (83.3%) and “getting into arguments with others” (irritability, 81%). Family relationships were reported to have been moderately or severely altered for 31% of patients, and 19% reported a severe deterioration in the overall quality of life (a decrease greater than 50%).
This study presents a very interesting look into the future of some of our injured athletes. It is greatly important to be reminded of how injuries sustained during athletic participation or practice can have a long-term, and in some cases life-long, affect on our patients. The most pronounced finding in this study was 19% deterioration in overall quality of life (a decrease greater than 50%). This should be a complication which clinicians should make their patients aware of both prior to, and after, a MTBI has been sustained. As most clinicians have experienced, athletes can be anxious to return to play and often inquire about this before all signs and symptoms have gone away. The information from this study can be used as a method to caution our patients and their families. Perhaps this information can also aid in seeking the highest quality care for our patients following an MTBI. In cases of depressive symptoms or emotional imbalance, we can refer out athletes to outside medical professionals (psychiatrist, psychologist, or consoling) with greater experience in the treatment of these symptoms. In the end our patient’s quality of life should be paramount at all times and our return to play decisions and guidance should echo the pitfalls of sustaining a serious head injury. So what have you found in your clinical experience? Have you had patients with long term PCS? At what level have you seen this, and have you been aware of disruptions in the patient’s family life or professional life?
Written by: Kyle Harris
Reviewed by: Stephen Thomas
Fourtassi M, Hajjioui A, Ouahabi AE, Benmassaoud H, Hajjaj-Hassouni N, & Khamlichi AE (2011). Long term outcome following mild traumatic brain injury in Moroccan patients. Clinical Neurology and Neurosurgery, 113 (9), 716-20 PMID: 21840643
I have had one patient with long term PCS at the collegiate level. It is a challenge to find/provide the support and care that an athlete experiencing post-concussion syndrome needs. There are absolutely disruptions to the athletes academic life (withdrawal from school for a semester) and their social life. I think that anything we as clinicians can do to educate athletes so that they report their injuries and take care of themselves, is completely warranted. Once an athlete has chosen to play without reporting injury, there's no taking it back. It's a decision that has ramifications that may last a short amount of time, but can last, as this study shows well over a year.
Great point. I too think the fight again PCS begins before the injury even occurs. I often tell my athletes that my focus is on them in 1, 2, 5 or even 10 years down the road. I also have shown many of my athletes this study illustrating the effects PCS can have. Do you have any special stragies to help your athletes understand the long term ramificaitons? I find that when I tell them, I have read studies which show X, Y and Z often they respond fairly favorable to that information. Have you tried this? If not, how do you think they would respond.