gms | German Medical Science

Aim: To evaluate extracranial injuries and their effect on return to work (RTW) and symptoms in mild traumatic brain injury (MTBI) patients using Injury Severity Score (ISS) and Abbreviated Injury Score (AIS).

Method: 130 MTBI patients were included, 114 of them currently employed or students and their full RTW was assessed. The symptoms of mild TBI were assessed by Rivermead Post-Concussion Symptom Questionnaire (RPQ) and their recovery measured by Glasgow Outcome Scale Extended Questionnaire (GOS-E) at 1 month after injury. Extracranial injuries were classified by ISS and AIS.

Results/findings: Full RTW rate at 1 year was 98.2% and median RTW was 9 days (SD 69.9). Median ISS was 6 (IQR 4-10). Mean RPQ was 10.90 (SD 9.80) and mean GOS-E 7.42 (SD 0.74). ISS was moderately correlated (0.455, p<0.001) with full RTW. AIS head (0.403, p<0.001), AIS external (0.261, p=0.005) and ISS total (excluding head injuries) (0.313, p=0.001) were also associated with slower RTW. Comparing patients with extracranial injuries (n=28) vs isolated MTBI, RTW for those with extracranial injuries was slower (20 vs. 7 days, p=0.003) and they reported extracranial pain more often (75.0% vs. 42.1%, p=0.002) and with higher severity (39.3% vs. 21.1% of patients with at least moderate pain, p=0.005). However, they did not report more symptoms in RPQ nor worse recovery in GOS-E at 1 month.

Discussion and conclusions: Extracranial injuries correlated with delayed RTW. ISS and RTW were correlated but ISS did not seem to correlate with post-concussion symptoms. The strength of correlation was from weak to moderate. Even bruises and wounds (AIS external) seemed to correlate with delayed RTW, which could be explained by longer recovery time, symptom burden or primary physician’s tendency to give longer leave of absence based on visual evidence of injury.