INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #50 Early Disability Trajectories following GCS-15 Traumatic Brain Injury Jasmine Morigney, University of Michigan, Ann Arbor, United States Ted Barrios, University of Michigan, Ann Arbor, United States Hayley Falk, University of Michigan, Ann Arbor, United States Adrianna Kallabat, University of Michigan, Ann Arbor, United States Nathan Roberts, University of Michigan, Ann Arbor, United States Frederick Korley, University of Michigan, Ann Arbor, United States Christopher Fung, University of Michigan, Ann Arbor, United States Nathan Haas, University of Michigan, Ann Arbor, United States Keith Kocher, University of Michigan, Ann Arbor, United States Carmen Gherasim, University of Michigan, Ann Arbor, United States Matthew Schipper, University of Michigan, Ann Arbor, United States Deb Demski, University of Michigan, Ann Arbor, United States James Devanney, University of Michigan, Ann Arbor, United States Justine Chea, University of Michigan, Ann Arbor, United States Richard Medlin, University of Michigan, Ann Arbor, United States Tian Xie, University of Michigan, Ann Arbor, United States Jerry Graham, University of Michigan, Ann Arbor, United States Jordan Sell, University of Michigan, Ann Arbor, United States Heather Molvik, University of Michigan, Ann Arbor, United States Miyant'e Newton, University of Michigan, Ann Arbor, United States Andrewq Askar, University of Michigan, Ann Arbor, United States Katharine Seagly, University of Michigan, Ann Arbor, United States Category: Concussion/Mild TBI (Adult) Keyword 1: concussion/ mild traumatic brain injury Objective: The Glasgow Outcome Scale-Extended (GOSE; Wilson et al., 1998) quantifies disability after traumatic brain injury (TBI). While commonly used, previous findings (e.g., Wilson et al., 2021) have indicated it may be inadequately sensitive to the more subtle (and fast recovering) neurocognitive sequelae of mild TBI. As such, we sought to clarify the properties of the GOSE within a sample of adults with GCS-15 TBI, the mildest form of TBI, treated in the emergency department (ED) at a major academic medical center (AMC). We did this by (a.) examining the stability between GOSE scores captured at two weeks and three months post-ED visit and (b.) using those data to segment our sample into GOSE-change-trajectory subgroups. Participants and Methods: Participants were >=18 years of age and evaluated at the ED for a trauma-related chief concern with plausible mechanism for brain injury. Evaluation was within 24 hours of injury and presenting GCS was 15. The 131 participants included in this specific set of analyses are a subset of a larger prospective TBI study for whom GOSE data were available at our two time points of interest. Scores on the GOSE range from 1 (deceased) to 8 (no disability), with intermediate scores reflecting varying degrees of disability. Participants were split approximately evenly in terms of sex (51.05% male) and were predominantly White (78.06%). Participants were diverse with respect to age (M = 53.11 years; SD = 18.59 years; range: 20.20-to-96.33 years). Primary analyses included two-step cluster analysis and post-hoc ANOVA. Results: On average, participants had a GOSE score of 6.79 (SD = 1.72; intercept) at two-week follow-up and 6.90 (SD = 1.66) at three-month follow-up (r = .50, p <.001). The average difference score between these two time points was small (M = 0.11; slope) albeit quite variable (SD = 1.69). Using these GOSE intercept and slope data as inputs, two-step cluster analysis revealed four distinct GOSE-change-trajectory subgroups: (a.) Minimal Disability + Minimal Change (65.65%; y = -0.09x + 7.73), (b.) Moderate/Severe Disability + Strong Recovery (17.56%; y = 2.48x + 4.70), (c.) Moderate/Severe Disability + Shallow Recovery (9.92%; y = 0.23x + 3.46), and (d.) Minimal Disability + Later Decline (6.87%; y = -4.22x + 8.00). This four-cluster solution adequately fit our sample’s data (silhouette coefficient [SC] = 0.7). Participants significantly differed in GOSE score across subgroups at both two-week (F[3] = 277.92; p<.001, η² = .87) and three-month follow-up (F[3] = 130.82; p < .001, η² = .76). Conclusions: Our sample was heterogenous with respect to trajectories of concussion recovery, which limited the utility of reviewing our sample’s average GOSE scores in aggregate; this was improved by segmenting our larger sample into GOSE-change-trajectory subgroups. As expected, the majority of participants (83.21%) followed a trajectory of either non-disability or improving disability. However, a sizable minority followed a trajectory of either persistent disability (9.92%) or, more confoundingly, precipitous functional decline (6.87%). Factors that drive these diverse concussion-recovery trajectories, particularly progressive loss of function, should be examined in future studies.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #50

Early Disability Trajectories following GCS-15 Traumatic Brain Injury

Jasmine Morigney, University of Michigan, Ann Arbor, United States
Ted Barrios, University of Michigan, Ann Arbor, United States
Hayley Falk, University of Michigan, Ann Arbor, United States
Adrianna Kallabat, University of Michigan, Ann Arbor, United States
Nathan Roberts, University of Michigan, Ann Arbor, United States
Frederick Korley, University of Michigan, Ann Arbor, United States
Christopher Fung, University of Michigan, Ann Arbor, United States
Nathan Haas, University of Michigan, Ann Arbor, United States
Keith Kocher, University of Michigan, Ann Arbor, United States
Carmen Gherasim, University of Michigan, Ann Arbor, United States
Matthew Schipper, University of Michigan, Ann Arbor, United States
Deb Demski, University of Michigan, Ann Arbor, United States
James Devanney, University of Michigan, Ann Arbor, United States
Justine Chea, University of Michigan, Ann Arbor, United States
Richard Medlin, University of Michigan, Ann Arbor, United States
Tian Xie, University of Michigan, Ann Arbor, United States
Jerry Graham, University of Michigan, Ann Arbor, United States
Jordan Sell, University of Michigan, Ann Arbor, United States
Heather Molvik, University of Michigan, Ann Arbor, United States
Miyant'e Newton, University of Michigan, Ann Arbor, United States
Andrewq Askar, University of Michigan, Ann Arbor, United States
Katharine Seagly, University of Michigan, Ann Arbor, United States

Category: Concussion/Mild TBI (Adult)

Keyword 1: concussion/ mild traumatic brain injury

Objective:

The Glasgow Outcome Scale-Extended (GOSE; Wilson et al., 1998) quantifies disability after traumatic brain injury (TBI). While commonly used, previous findings (e.g., Wilson et al., 2021) have indicated it may be inadequately sensitive to the more subtle (and fast recovering) neurocognitive sequelae of mild TBI. As such, we sought to clarify the properties of the GOSE within a sample of adults with GCS-15 TBI, the mildest form of TBI, treated in the emergency department (ED) at a major academic medical center (AMC). We did this by (a.) examining the stability between GOSE scores captured at two weeks and three months post-ED visit and (b.) using those data to segment our sample into GOSE-change-trajectory subgroups.

Participants and Methods:

Participants were >=18 years of age and evaluated at the ED for a trauma-related chief concern with plausible mechanism for brain injury. Evaluation was within 24 hours of injury and presenting GCS was 15. The 131 participants included in this specific set of analyses are a subset of a larger prospective TBI study for whom GOSE data were available at our two time points of interest. Scores on the GOSE range from 1 (deceased) to 8 (no disability), with intermediate scores reflecting varying degrees of disability. Participants were split approximately evenly in terms of sex (51.05% male) and were predominantly White (78.06%). Participants were diverse with respect to age (M = 53.11 years; SD = 18.59 years; range: 20.20-to-96.33 years). Primary analyses included two-step cluster analysis and post-hoc ANOVA.

Results:

On average, participants had a GOSE score of 6.79 (SD = 1.72; intercept) at two-week follow-up and 6.90 (SD = 1.66) at three-month follow-up (r = .50, p <.001). The average difference score between these two time points was small (M = 0.11; slope) albeit quite variable (SD = 1.69). Using these GOSE intercept and slope data as inputs, two-step cluster analysis revealed four distinct GOSE-change-trajectory subgroups: (a.) Minimal Disability + Minimal Change (65.65%; y = -0.09x + 7.73), (b.) Moderate/Severe Disability + Strong Recovery (17.56%; y = 2.48x + 4.70), (c.) Moderate/Severe Disability + Shallow Recovery (9.92%; y = 0.23x + 3.46), and (d.) Minimal Disability + Later Decline (6.87%; y = -4.22x + 8.00). This four-cluster solution adequately fit our sample’s data (silhouette coefficient [SC] = 0.7). Participants significantly differed in GOSE score across subgroups at both two-week (F[3] = 277.92; p<.001, η² = .87) and three-month follow-up (F[3] = 130.82; p < .001, η² = .76).

Conclusions:

Our sample was heterogenous with respect to trajectories of concussion recovery, which limited the utility of reviewing our sample’s average GOSE scores in aggregate; this was improved by segmenting our larger sample into GOSE-change-trajectory subgroups. As expected, the majority of participants (83.21%) followed a trajectory of either non-disability or improving disability. However, a sizable minority followed a trajectory of either persistent disability (9.92%) or, more confoundingly, precipitous functional decline (6.87%). Factors that drive these diverse concussion-recovery trajectories, particularly progressive loss of function, should be examined in future studies.