Prognosis

Brain recovery is defined as resolution of symptoms, return to baseline cognitive performance, and no symptoms on exertion. A common misconception is that almost all patients with mild TBI will make a full recovery.[2]​ Although some systematic reviews suggested recovery from symptoms by 3-12 months post-injury, these reviews included studies with small sample sizes and high loss-to-follow-up rates.[78][79][80]​​​​​​​​ Subsequent longitudinal research suggests that more than half of patients with mild TBI have functional impairments (e.g., reduced work capacity, problems with social function, family disruption) at 12 months after injury and 42% to 49% of those with mild TBI experience at least four symptoms at 12 months.​[80][81]​​​​​​​ The most prevalent chronic symptoms are headaches, difficulty concentrating, fatigue, and dizziness.[82]​ Physical symptoms decline more markedly over time, whereas cognitive symptoms are more constant over time and become the most prevalent of the two by 3-6 months post-injury.[80]​ One observational prospective cohort study showed accuracy of clinical gestalt for predicting mild TBI outcomes is poor. Of 217 mild TBI cases, whilst clinicians predicted that 90% of patients would fully recover by 6 months, only 50% achieved full functional and symptomatic recovery.[83] In one study of concussed athletes (n=1751, 19.2 years, 63.2% male) participants in 22 different sports began the return to participation (RTP) protocol in a median of 6.4 days and the median total RTP duration was 12.8 days.[84]​​ Clinical symptoms of sports-related mild TBI typically resolve spontaneously, with 80% to 90% of concussed older adolescents and adults returning to preinjury levels of clinical function within 2 weeks.[3][85]​​​ In younger athletes, clinical recovery may take longer, with return to preinjury levels of function within 4 weeks.​[3][86]

One systematic review revealed that 93% of athletes of all ages have a full return to learning with no additional academic support by 10 days.[87]​ While many students can quickly return to learning with no or minimal difficulty, the process can be more challenging for those who have specific considerations (eg, high acute symptom severity, a prior learning disability) that may affect recovery.[7]

Other prognostic factors include:

  • Psychiatric comorbidity: In adults, pre-injury mental health problems and post-injury psychological distress (symptoms of depression and anxiety) are robust predictors of prolonged recovery.[88][89][90]​ ​Depression and/or PTSD are associated with a considerable decrease in functional outcome and health-related quality of life.[91]

  • Previous injuries: prior injuries increase the likelihood for future injury and complicate symptom resolution.[4][81]​​[92]

  • Female sex: retrospective analysis of young athletes (aged 11-18 years) with a first-time mild TBI sustained while playing organised sport found that female athletes remained symptomatic for a median 28 days, compared with 11 days for male athletes of similar age, irrespective of the sport played.[93]

Use of this content is subject to our disclaimer