Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks after Traumatic Brain Injury: Findings from the TRACK-TBI Study

Benjamin L. Brett; Mark D. Kramer; John Whyte; Michael A. McCrea; Murray B. Stein; Joseph T. Giacino; Mark Sherer; Amy J. Markowitz; Geoffrey T. Manley; Lindsay D. Nelson; Opeolu Adeoye; Neeraj Badjatia; Kim Boase; Jason Barber; Yelena Bodien; M. Ross Bullock; Randall Chesnut; John D. Corrigan; Karen Crawford; Ramon Diaz-Arrastia; Sureyya Dikmen; Ann Christine Duhaime; Richard Ellenbogen; V. Ramana Feeser; Adam R. Ferguson; Brandon Foreman; Raquel Gardner; Etienne Gaudette; Luis Gonzalez; Shankar Gopinath; Rao Gullapalli; J. Claude Hemphill; Gillian Hotz; Sonia Jain; C. Dirk Keene; Frederick K. Korley; Joel Kramer; Natalie Kreitzer; Harvey Levin; Chris Lindsell; Joan Machamer; Christopher Madden; Alastair Martin; Thomas McAllister; Randall Merchant; Pratik Mukherjee; Laura B. Ngwenya; Florence Noel; David Okonkwo; Eva Palacios; Ava Puccio; Miri Rabinowitz; Claudia Robertson; Jonathan Rosand; Angelle Sander; Gabriella Satris; David Schnyer; Seth Seabury; Sabrina Taylor; Nancy Temkin; Arthur Toga; Alex Valadka; Mary Vassar; Kevin Wang; John K. Yue; Esther Yuh; Ross Zafonte

doi:10.1001/jamanetworkopen.2021.3467

Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks after Traumatic Brain Injury: Findings from the TRACK-TBI Study

Benjamin L. Brett, Mark D. Kramer, John Whyte, Michael A. McCrea, Murray B. Stein, Joseph T. Giacino, Mark Sherer, Amy J. Markowitz, Geoffrey T. Manley, Lindsay D. Nelson, Opeolu Adeoye, Neeraj Badjatia, Kim Boase, Jason Barber, Yelena Bodien, M. Ross Bullock, Randall Chesnut, John D. Corrigan, Karen Crawford, Ramon Diaz-ArrastiaSureyya Dikmen, Ann Christine Duhaime, Richard Ellenbogen, V. Ramana Feeser, Adam R. Ferguson, Brandon Foreman, Raquel Gardner, Etienne Gaudette, Luis Gonzalez, Shankar Gopinath, Rao Gullapalli, J. Claude Hemphill, Gillian Hotz, Sonia Jain, C. Dirk Keene, Frederick K. Korley, Joel Kramer, Natalie Kreitzer, Harvey Levin, Chris Lindsell, Joan Machamer, Christopher Madden, Alastair Martin, Thomas McAllister, Randall Merchant, Pratik Mukherjee, Laura B. Ngwenya, Florence Noel, David Okonkwo, Eva Palacios, Ava Puccio, Miri Rabinowitz, Claudia Robertson, Jonathan Rosand, Angelle Sander, Gabriella Satris, David Schnyer, Seth Seabury, Sabrina Taylor, Nancy Temkin, Arthur Toga, Alex Valadka, Mary Vassar, Kevin Wang, John K. Yue, Esther Yuh, Ross Zafonte

Research output: Contribution to journal › Article › peer-review

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Abstract

Importance: Heterogeneity across patients with traumatic brain injury (TBI) presents challenges for clinical care and intervention design. Identifying distinct clinical phenotypes of TBI soon after injury may inform patient selection for precision medicine clinical trials. Objective: To investigate whether distinct neurobehavioral phenotypes can be identified 2 weeks after TBI and to characterize the degree to which early neurobehavioral phenotypes are associated with 6-month outcomes. Design, Setting, and Participants: This prospective cohort study included patients presenting to 18 US level 1 trauma centers within 24 hours of TBI from 2014 to 2019 as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Data were analyzed from January 28, 2020, to January 11, 2021. Exposures: TBI. Main Outcomes and Measures: Latent profiles (LPs) were derived from common dimensions of neurobehavioral functioning at 2 weeks after injury, assessed through National Institutes of Health TBI Common Data Elements (ie, Brief Symptom Inventory-18, Patient Health Questionnaire-9 Depression checklist, Posttraumatic Stress Disorder Checklist for DSM-5, PROMIS Pain Intensity scale, Insomnia Severity Index, Rey Auditory Verbal Learning Test, Wechsler Adult Intelligence Scale-Fourth Edition Coding and Symbol Search subtests, Trail Making Test, and NIH Toolbox Cognitive Battery Pattern Comparison Processing Speed, Dimensional Change Card Sort, Flanker Inhibitory Control and Attention, and Picture Sequence Memory subtests). Six-month outcomes were the Satisfaction With Life Scale (SWLS), Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), Glasgow Outcome Scale-Extended (GOSE), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Results: Among 1757 patients with TBI included, 1184 (67.4%) were men, and the mean (SD) age was 39.9 (17.0) years. LP analysis revealed 4 distinct neurobehavioral phenotypes at 2 weeks after injury: emotionally resilient (419 individuals [23.8%]), cognitively impaired (368 individuals [20.9%]), cognitively resilient (620 individuals [35.3%]), and neuropsychiatrically distressed (with cognitive weaknesses; 350 individuals [19.9%]). Adding LP group to models including demographic characteristics, medical history, Glasgow Coma Scale score, and other injury characteristics was associated with significantly improved estimation of association with 6-month outcome (GOSE R²increase = 0.09-0.19; SWLS R²increase = 0.12-0.22; QOLIBRI-OS R²increase = 0.14-0.32; RPQ R²= 0.13-0.34). Conclusions and Relevance: In this cohort study of patients with TBI presenting to US level-1 trauma centers, qualitatively distinct profiles of symptoms and cognitive functioning were identified at 2 weeks after TBI. These distinct phenotypes may help optimize clinical decision-making regarding prognosis, as well as selection and stratification for randomized clinical trials.

Original language	English (US)
Article number	e213467
Journal	JAMA Network Open
Volume	4
Issue number	3
DOIs	https://doi.org/10.1001/jamanetworkopen.2021.3467
State	Published - Mar 30 2021

ASJC Scopus subject areas

General Medicine

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Brett, B. L., Kramer, M. D., Whyte, J., McCrea, M. A., Stein, M. B., Giacino, J. T., Sherer, M., Markowitz, A. J., Manley, G. T., Nelson, L. D., Adeoye, O., Badjatia, N., Boase, K., Barber, J., Bodien, Y., Bullock, M. R., Chesnut, R., Corrigan, J. D., Crawford, K., ... Zafonte, R. (2021). Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks after Traumatic Brain Injury: Findings from the TRACK-TBI Study. JAMA Network Open, 4(3), Article e213467. https://doi.org/10.1001/jamanetworkopen.2021.3467

Brett, BL, Kramer, MD, Whyte, J, McCrea, MA, Stein, MB, Giacino, JT, Sherer, M, Markowitz, AJ, Manley, GT, Nelson, LD, Adeoye, O, Badjatia, N, Boase, K, Barber, J, Bodien, Y, Bullock, MR, Chesnut, R, Corrigan, JD, Crawford, K, Diaz-Arrastia, R, Dikmen, S, Duhaime, AC, Ellenbogen, R, Feeser, VR, Ferguson, AR, Foreman, B, Gardner, R, Gaudette, E, Gonzalez, L, Gopinath, S, Gullapalli, R, Hemphill, JC, Hotz, G, Jain, S, Keene, CD, Korley, FK, Kramer, J, Kreitzer, N, Levin, H, Lindsell, C, Machamer, J, Madden, C, Martin, A, McAllister, T, Merchant, R, Mukherjee, P, Ngwenya, LB, Noel, F, Okonkwo, D, Palacios, E, Puccio, A, Rabinowitz, M, Robertson, C, Rosand, J, Sander, A, Satris, G, Schnyer, D, Seabury, S, Taylor, S, Temkin, N, Toga, A, Valadka, A, Vassar, M, Wang, K, Yue, JK, Yuh, E & Zafonte, R 2021, 'Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks after Traumatic Brain Injury: Findings from the TRACK-TBI Study', JAMA Network Open, vol. 4, no. 3, e213467. https://doi.org/10.1001/jamanetworkopen.2021.3467

@article{9a5a3ec7009f4243860abb34ea51071a,

title = "Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks after Traumatic Brain Injury: Findings from the TRACK-TBI Study",

abstract = "Importance: Heterogeneity across patients with traumatic brain injury (TBI) presents challenges for clinical care and intervention design. Identifying distinct clinical phenotypes of TBI soon after injury may inform patient selection for precision medicine clinical trials. Objective: To investigate whether distinct neurobehavioral phenotypes can be identified 2 weeks after TBI and to characterize the degree to which early neurobehavioral phenotypes are associated with 6-month outcomes. Design, Setting, and Participants: This prospective cohort study included patients presenting to 18 US level 1 trauma centers within 24 hours of TBI from 2014 to 2019 as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Data were analyzed from January 28, 2020, to January 11, 2021. Exposures: TBI. Main Outcomes and Measures: Latent profiles (LPs) were derived from common dimensions of neurobehavioral functioning at 2 weeks after injury, assessed through National Institutes of Health TBI Common Data Elements (ie, Brief Symptom Inventory-18, Patient Health Questionnaire-9 Depression checklist, Posttraumatic Stress Disorder Checklist for DSM-5, PROMIS Pain Intensity scale, Insomnia Severity Index, Rey Auditory Verbal Learning Test, Wechsler Adult Intelligence Scale-Fourth Edition Coding and Symbol Search subtests, Trail Making Test, and NIH Toolbox Cognitive Battery Pattern Comparison Processing Speed, Dimensional Change Card Sort, Flanker Inhibitory Control and Attention, and Picture Sequence Memory subtests). Six-month outcomes were the Satisfaction With Life Scale (SWLS), Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), Glasgow Outcome Scale-Extended (GOSE), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Results: Among 1757 patients with TBI included, 1184 (67.4%) were men, and the mean (SD) age was 39.9 (17.0) years. LP analysis revealed 4 distinct neurobehavioral phenotypes at 2 weeks after injury: emotionally resilient (419 individuals [23.8%]), cognitively impaired (368 individuals [20.9%]), cognitively resilient (620 individuals [35.3%]), and neuropsychiatrically distressed (with cognitive weaknesses; 350 individuals [19.9%]). Adding LP group to models including demographic characteristics, medical history, Glasgow Coma Scale score, and other injury characteristics was associated with significantly improved estimation of association with 6-month outcome (GOSE R2increase = 0.09-0.19; SWLS R2increase = 0.12-0.22; QOLIBRI-OS R2increase = 0.14-0.32; RPQ R2= 0.13-0.34). Conclusions and Relevance: In this cohort study of patients with TBI presenting to US level-1 trauma centers, qualitatively distinct profiles of symptoms and cognitive functioning were identified at 2 weeks after TBI. These distinct phenotypes may help optimize clinical decision-making regarding prognosis, as well as selection and stratification for randomized clinical trials.",

author = "Brett, {Benjamin L.} and Kramer, {Mark D.} and John Whyte and McCrea, {Michael A.} and Stein, {Murray B.} and Giacino, {Joseph T.} and Mark Sherer and Markowitz, {Amy J.} and Manley, {Geoffrey T.} and Nelson, {Lindsay D.} and Opeolu Adeoye and Neeraj Badjatia and Kim Boase and Jason Barber and Yelena Bodien and Bullock, {M. Ross} and Randall Chesnut and Corrigan, {John D.} and Karen Crawford and Ramon Diaz-Arrastia and Sureyya Dikmen and Duhaime, {Ann Christine} and Richard Ellenbogen and Feeser, {V. Ramana} and Ferguson, {Adam R.} and Brandon Foreman and Raquel Gardner and Etienne Gaudette and Luis Gonzalez and Shankar Gopinath and Rao Gullapalli and Hemphill, {J. Claude} and Gillian Hotz and Sonia Jain and Keene, {C. Dirk} and Korley, {Frederick K.} and Joel Kramer and Natalie Kreitzer and Harvey Levin and Chris Lindsell and Joan Machamer and Christopher Madden and Alastair Martin and Thomas McAllister and Randall Merchant and Pratik Mukherjee and Ngwenya, {Laura B.} and Florence Noel and David Okonkwo and Eva Palacios and Ava Puccio and Miri Rabinowitz and Claudia Robertson and Jonathan Rosand and Angelle Sander and Gabriella Satris and David Schnyer and Seth Seabury and Sabrina Taylor and Nancy Temkin and Arthur Toga and Alex Valadka and Mary Vassar and Kevin Wang and Yue, {John K.} and Esther Yuh and Ross Zafonte",

year = "2021",

month = mar,

day = "30",

doi = "10.1001/jamanetworkopen.2021.3467",

language = "English (US)",

volume = "4",

journal = "JAMA Network Open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "3",

}

TY - JOUR

T1 - Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks after Traumatic Brain Injury

T2 - Findings from the TRACK-TBI Study

AU - Brett, Benjamin L.

AU - Kramer, Mark D.

AU - Whyte, John

AU - McCrea, Michael A.

AU - Stein, Murray B.

AU - Giacino, Joseph T.

AU - Sherer, Mark

AU - Markowitz, Amy J.

AU - Manley, Geoffrey T.

AU - Nelson, Lindsay D.

AU - Adeoye, Opeolu

AU - Badjatia, Neeraj

AU - Boase, Kim

AU - Barber, Jason

AU - Bodien, Yelena

AU - Bullock, M. Ross

AU - Chesnut, Randall

AU - Corrigan, John D.

AU - Crawford, Karen

AU - Diaz-Arrastia, Ramon

AU - Dikmen, Sureyya

AU - Duhaime, Ann Christine

AU - Ellenbogen, Richard

AU - Feeser, V. Ramana

AU - Ferguson, Adam R.

AU - Foreman, Brandon

AU - Gardner, Raquel

AU - Gaudette, Etienne

AU - Gonzalez, Luis

AU - Gopinath, Shankar

AU - Gullapalli, Rao

AU - Hemphill, J. Claude

AU - Hotz, Gillian

AU - Jain, Sonia

AU - Keene, C. Dirk

AU - Korley, Frederick K.

AU - Kramer, Joel

AU - Kreitzer, Natalie

AU - Levin, Harvey

AU - Lindsell, Chris

AU - Machamer, Joan

AU - Madden, Christopher

AU - Martin, Alastair

AU - McAllister, Thomas

AU - Merchant, Randall

AU - Mukherjee, Pratik

AU - Ngwenya, Laura B.

AU - Noel, Florence

AU - Okonkwo, David

AU - Palacios, Eva

AU - Puccio, Ava

AU - Rabinowitz, Miri

AU - Robertson, Claudia

AU - Rosand, Jonathan

AU - Sander, Angelle

AU - Satris, Gabriella

AU - Schnyer, David

AU - Seabury, Seth

AU - Taylor, Sabrina

AU - Temkin, Nancy

AU - Toga, Arthur

AU - Valadka, Alex

AU - Vassar, Mary

AU - Wang, Kevin

AU - Yue, John K.

AU - Yuh, Esther

AU - Zafonte, Ross

PY - 2021/3/30

Y1 - 2021/3/30

N2 - Importance: Heterogeneity across patients with traumatic brain injury (TBI) presents challenges for clinical care and intervention design. Identifying distinct clinical phenotypes of TBI soon after injury may inform patient selection for precision medicine clinical trials. Objective: To investigate whether distinct neurobehavioral phenotypes can be identified 2 weeks after TBI and to characterize the degree to which early neurobehavioral phenotypes are associated with 6-month outcomes. Design, Setting, and Participants: This prospective cohort study included patients presenting to 18 US level 1 trauma centers within 24 hours of TBI from 2014 to 2019 as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Data were analyzed from January 28, 2020, to January 11, 2021. Exposures: TBI. Main Outcomes and Measures: Latent profiles (LPs) were derived from common dimensions of neurobehavioral functioning at 2 weeks after injury, assessed through National Institutes of Health TBI Common Data Elements (ie, Brief Symptom Inventory-18, Patient Health Questionnaire-9 Depression checklist, Posttraumatic Stress Disorder Checklist for DSM-5, PROMIS Pain Intensity scale, Insomnia Severity Index, Rey Auditory Verbal Learning Test, Wechsler Adult Intelligence Scale-Fourth Edition Coding and Symbol Search subtests, Trail Making Test, and NIH Toolbox Cognitive Battery Pattern Comparison Processing Speed, Dimensional Change Card Sort, Flanker Inhibitory Control and Attention, and Picture Sequence Memory subtests). Six-month outcomes were the Satisfaction With Life Scale (SWLS), Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), Glasgow Outcome Scale-Extended (GOSE), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Results: Among 1757 patients with TBI included, 1184 (67.4%) were men, and the mean (SD) age was 39.9 (17.0) years. LP analysis revealed 4 distinct neurobehavioral phenotypes at 2 weeks after injury: emotionally resilient (419 individuals [23.8%]), cognitively impaired (368 individuals [20.9%]), cognitively resilient (620 individuals [35.3%]), and neuropsychiatrically distressed (with cognitive weaknesses; 350 individuals [19.9%]). Adding LP group to models including demographic characteristics, medical history, Glasgow Coma Scale score, and other injury characteristics was associated with significantly improved estimation of association with 6-month outcome (GOSE R2increase = 0.09-0.19; SWLS R2increase = 0.12-0.22; QOLIBRI-OS R2increase = 0.14-0.32; RPQ R2= 0.13-0.34). Conclusions and Relevance: In this cohort study of patients with TBI presenting to US level-1 trauma centers, qualitatively distinct profiles of symptoms and cognitive functioning were identified at 2 weeks after TBI. These distinct phenotypes may help optimize clinical decision-making regarding prognosis, as well as selection and stratification for randomized clinical trials.

AB - Importance: Heterogeneity across patients with traumatic brain injury (TBI) presents challenges for clinical care and intervention design. Identifying distinct clinical phenotypes of TBI soon after injury may inform patient selection for precision medicine clinical trials. Objective: To investigate whether distinct neurobehavioral phenotypes can be identified 2 weeks after TBI and to characterize the degree to which early neurobehavioral phenotypes are associated with 6-month outcomes. Design, Setting, and Participants: This prospective cohort study included patients presenting to 18 US level 1 trauma centers within 24 hours of TBI from 2014 to 2019 as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Data were analyzed from January 28, 2020, to January 11, 2021. Exposures: TBI. Main Outcomes and Measures: Latent profiles (LPs) were derived from common dimensions of neurobehavioral functioning at 2 weeks after injury, assessed through National Institutes of Health TBI Common Data Elements (ie, Brief Symptom Inventory-18, Patient Health Questionnaire-9 Depression checklist, Posttraumatic Stress Disorder Checklist for DSM-5, PROMIS Pain Intensity scale, Insomnia Severity Index, Rey Auditory Verbal Learning Test, Wechsler Adult Intelligence Scale-Fourth Edition Coding and Symbol Search subtests, Trail Making Test, and NIH Toolbox Cognitive Battery Pattern Comparison Processing Speed, Dimensional Change Card Sort, Flanker Inhibitory Control and Attention, and Picture Sequence Memory subtests). Six-month outcomes were the Satisfaction With Life Scale (SWLS), Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), Glasgow Outcome Scale-Extended (GOSE), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Results: Among 1757 patients with TBI included, 1184 (67.4%) were men, and the mean (SD) age was 39.9 (17.0) years. LP analysis revealed 4 distinct neurobehavioral phenotypes at 2 weeks after injury: emotionally resilient (419 individuals [23.8%]), cognitively impaired (368 individuals [20.9%]), cognitively resilient (620 individuals [35.3%]), and neuropsychiatrically distressed (with cognitive weaknesses; 350 individuals [19.9%]). Adding LP group to models including demographic characteristics, medical history, Glasgow Coma Scale score, and other injury characteristics was associated with significantly improved estimation of association with 6-month outcome (GOSE R2increase = 0.09-0.19; SWLS R2increase = 0.12-0.22; QOLIBRI-OS R2increase = 0.14-0.32; RPQ R2= 0.13-0.34). Conclusions and Relevance: In this cohort study of patients with TBI presenting to US level-1 trauma centers, qualitatively distinct profiles of symptoms and cognitive functioning were identified at 2 weeks after TBI. These distinct phenotypes may help optimize clinical decision-making regarding prognosis, as well as selection and stratification for randomized clinical trials.

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DO - 10.1001/jamanetworkopen.2021.3467

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SN - 2574-3805

VL - 4

JO - JAMA Network Open

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ER -

Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks after Traumatic Brain Injury: Findings from the TRACK-TBI Study

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