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The heterogeneity of mild traumatic brain injury: Where do we stand? 

Authors: Andreacutee Tellier a;  Shawn C. Marshall b;  Keith G. Wilson c;  Andra Smith d;  Mary Perugini c; Ian Gilmour Stiell e
Affiliations:   a Department of Psychology (Neuropsychology Service), The Ottawa Hospital, Ottawa, Ontario, Canada
b Department of Medicine, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
c Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
d School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
e Clinical Epidemiology Unit, Loeb Research Institute, University of Ottawa, Ottawa, Ontario, Canada
DOI: 10.1080/02699050903200555
Publication Frequency: 14 issues per year
Published in: journal Brain Injury, Volume 23, Issue 11 October 2009 , pages 879 - 887
Formats available: HTML (English) : PDF (English)
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Abstract

Primary objective: To explore the heterogeneity of mild traumatic brain injury (mTBI).

Methods and procedures: Hospital-based prospective follow-up study of 125 patients with mTBI sub-divided into 'severity' sub-groups on the basis of GCS scores (GCS of 15 = mild sub-group; GCS of 13-14 = moderate sub-group). Post-traumatic amnesia (PTA) duration (30 minutes used as a cut-off) was also used to define group membership for secondary analyses. The follow-up assessment consisted of a brief neuropsychological battery as well as measures of neurobehavioural functioning, community integration and post-concussive symptomatology. CT scanning was also obtained when clinically relevant.

Main outcomes and results: The two mTBI sub-groups, as defined by GCS scores, did not differ with respect to post-concussive symptomatology, neurobehavioural symptoms, neuropsychological performance or CT scan abnormalities. In contrast, when group membership was redefined on the basis of PTA, the two sub-groups differed significantly with respect to intracranial abnormalities and report of aggressive or disinhibited behaviours at the 6-month mark.

Conclusions: While the notion of heterogeneity in mTBI was not supported when severity was based on GCS scores, there was partial support when PTA duration was used as a measure of severity.
Keywords: Glasgow Coma Scale; mild brain injury; outcome; traumatic brain injury
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