학술논문
Preinjury employment status as a risk factor for symptomatology and disability in mild traumatic brain injury: A TRACK-TBI analysis.
Document Type
Article
Author
TRACK-TBI Investigators; Yue, John K.; Rick, Jonathan W.; Morrissey, Molly Rose; Taylor, Sabrina R.; Deng, Hansen; Suen, Catherine G.; Vassar, Mary J.; Cage, Tene A.; Manley, Geoffrey T.; Hricik, Allison J.; Maas, Andrew I. R.; Menon, David K.; Puccio, Ava M.; Schnyer, David M.; Yuh, Esther L.; Mukherjee, Pratik; Cnossen, Maryse C.; Lingsma, Hester F.; Gardner, Raquel C.
Source
Subject
*PSYCHIATRIC diagnosis
*DIAGNOSIS of post-traumatic stress disorder
*POSTCONCUSSION syndrome
*BRAIN injuries
*CONFIDENCE intervals
*CONVALESCENCE
*NEUROLOGIC examination
*EMPLOYMENT
*EPIDEMIOLOGY
*MULTIVARIATE analysis
*QUESTIONNAIRES
*RISK assessment
*SMOKING
*SUBSTANCE abuse
*UNEMPLOYMENT
*WOUNDS & injuries
*COMORBIDITY
*PILOT projects
*MULTIPLE regression analysis
*STATISTICAL significance
*EDUCATIONAL attainment
*REHABILITATION for brain injury patients
*FUNCTIONAL assessment
*BRIEF Symptom Inventory
*SYMPTOMS
*DIAGNOSIS
*PSYCHOLOGY
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Language
ISSN
1053-8135
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. [ABSTRACT FROM AUTHOR]