Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks After Traumatic Brain Injury: Findings From the TRACK-TBI Study.
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Brett Benjamin L, Kramer Mark D, Whyte John, McCrea Michael A, Stein Murray B, Giacino Joseph T, Sherer Mark, Markowitz Amy J, Manley Geoffrey T, Nelson Lindsay D, TRACK-TBI Investigators, Adeoye Opeolu, Badjatia Neeraj, Boase Kim, Barber Jason, Bodien Yelena, Bullock M Ross, Chesnut Randall, Corrigan John D, Crawford Karen, Diaz-Arrastia Ramon, Dikmen Sureyya, Duhaime Ann-Christine, Ellenbogen Richard, Feeser V Ramana, Ferguson Adam R, Foreman Brandon, Gardner Raquel, Gaudette Etienne, Gonzalez Luis, Gopinath Shankar, Gullapalli Rao, Hemphill J Claude, Hotz Gillian, Jain Sonia, Keene C Dirk, Korley Frederick K, Kramer Joel, Kreitzer Natalie, Levin Harvey, Lindsell Chris, Machamer Joan, Madden Christopher, Martin Alastair, McAllister Thomas, Merchant Randall, Mukherjee Pratik, Ngwenya Laura B, Noel Florence, Okonkwo David, Palacios Eva, Puccio Ava, Rabinowitz Miri, Robertson Claudia, Rosand Jonathan, Sander Angelle, Satris Gabriella, Schnyer David, Seabury Seth, Taylor Sabrina, Temkin Nancy, Toga Arthur, Valadka Alex, Vassar Mary, Wang Kevin, Yue John K, Yuh Esther, Zafonte Ross
Аннотация
OBJECTIVE: To investigate whether distinct neurobehavioral phenotypes can be identified 2 weeks after TBI and to characterize the degree to which early neurobehavioral phenotypes are associated with 6-month outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included patients presenting to 18 US level 1 trauma centers within 24 hours of TBI from 2014 to 2019 as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Data were analyzed from January 28, 2020, to January 11, 2021.
EXPOSURES: TBI.
MAIN OUTCOMES AND MEASURES: Latent profiles (LPs) were derived from common dimensions of neurobehavioral functioning at 2 weeks after injury, assessed through National Institutes of Health TBI Common Data Elements (ie, Brief Symptom Inventory-18, Patient Health Questionnaire-9 Depression checklist, Posttraumatic Stress Disorder Checklist for DSM-5, PROMIS Pain Intensity scale, Insomnia Severity Index, Rey Auditory Verbal Learning Test, Wechsler Adult Intelligence Scale-Fourth Edition Coding and Symbol Search subtests, Trail Making Test, and NIH Toolbox Cognitive Battery Pattern Comparison Processing Speed, Dimensional Change Card Sort, Flanker Inhibitory Control and Attention, and Picture Sequence Memory subtests). Six-month outcomes were the Satisfaction With Life Scale (SWLS), Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), Glasgow Outcome Scale-Extended (GOSE), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ).
RESULTS: Among 1757 patients with TBI included, 1184 (67.4%) were men, and the mean (SD) age was 39.9 (17.0) years. LP analysis revealed 4 distinct neurobehavioral phenotypes at 2 weeks after injury: emotionally resilient (419 individuals [23.8%]), cognitively impaired (368 individuals [20.9%]), cognitively resilient (620 individuals [35.3%]), and neuropsychiatrically distressed (with cognitive weaknesses; 350 individuals [19.9%]). Adding LP group to models including demographic characteristics, medical history, Glasgow Coma Scale score, and other injury characteristics was associated with significantly improved estimation of association with 6-month outcome (GOSE R2 increase = 0.09-0.19; SWLS R2 increase = 0.12-0.22; QOLIBRI-OS R2 increase = 0.14-0.32; RPQ R2 = 0.13-0.34).
CONCLUSIONS AND RELEVANCE: In this cohort study of patients with TBI presenting to US level-1 trauma centers, qualitatively distinct profiles of symptoms and cognitive functioning were identified at 2 weeks after TBI. These distinct phenotypes may help optimize clinical decision-making regarding prognosis, as well as selection and stratification for randomized clinical trials.