Determinants of long-term health-related quality of life in adult patients with mild traumatic brain injury

  • Shahrokh Yousefzadeh-Chabok
  • Fatemeh Ramezani Kapourchali
  • Sara RamezaniEmail author
Original Article



Mild traumatic brain injury (mTBI) usually leads to the appearance of post-concussion symptoms (PCS) which may resolve after a short time. In this study, the mental and physical aspects of quality of life (QoL) were evaluated 6 months after mTBI, and the association of demographic and injury-related factors, post-injury primary executive function and PCS types with the long-term QoL status was investigated.


123 eligible mTBI patients of initial sampling participated in follow-up phase of this longitudinal study. The demographic, clinical, and para-clinical data of patients were recorded. Paraclinical data comprised brain lesion volume, type and location determined by CT scan. The executive function and primary PCS were examined during the discharge using the verbal fluency task and a checklist, respectively. QoL was measured via SF-36 questionnaire. The collected data were entered into SPSS 22, and analyzed using appropriate statistical tests.


Youngers aged between 18 and 35 years and women had a lower QoL score than others. Primary somatic and cognitive PCS together were associated with poor QoL. There was no significant difference in QoL and executive function scores between the normal and abnormal brain CT groups. However, among people with abnormal CT, those having multifocal lesions including at least an intracranial hemorrhage type such as intra parenchymal hemorrhage or extra-axial bleeding together with other intracranial lesions or skull fracture demonstrated less QoL score in SF-36. A significant correlation was discovered between the scores of the executive function and QoL in mental dimensions of SF-36.


This study emphasizes on the clinical significance of early executive function and PCS examination in mTBI population, as well as optimal management of the victims regardless of the initial brain CT findings, especially in high-risk populations.


Executive function Post-concussion symptoms Minor brain trauma Neuroimaging SF-36 



The authors are grateful to the staff of the Neurosurgery and Emergency departments of Poursina hospital, Rasht, Iran and the staff at Guilan Road Trauma Research Center, Poursina General Hospital, Rasht, Iran for their valuable support in data collection.

Compliance with ethical standards

Conflict of interest

The authors mention that there is no conflict of interest in this study.

Ethical approval

Research has been performed in accordance with the Declaration of Helsinki about human subjects that have been approved by the ethical committee of Guilan University of medical sciences. Based on the guidelines regulated in the Declaration of Helsinki, written informed consent was obtained from all subjects. Also authors mention that there is no conflict of interest in this study.


  1. 1.
    Silver JM, McAllister TW, Yudofsky SC. Textbook of traumatic brain injury: Am Psychiatr Pub. 2011;1:3–25.Google Scholar
  2. 2.
    Rahimi-Movaghar V, Rasouli MR, Ghahramani M. The incidence of traumatic brain injury in Tehran, Iran: a population based study. Am Surg. 2011;77(6):E112.PubMedGoogle Scholar
  3. 3.
    Vafaee R, Vafaei A, Forouzanfar MM, Asadollahi S, Kashani P, Heidari K, et al. Epidemiology of traumatic brain injury in Iranian population: the results of a multicenter study. Wulfenia. 2013;20(9):257–63.Google Scholar
  4. 4.
    Petchprapai N, Winkelman C. Mild traumatic brain injury: determinants and subsequent quality of life: a review of the literature. J Neurosci Nurs. 2007;39(5):260–72.CrossRefGoogle Scholar
  5. 5.
    Sussman ES, Pendharkar AV, Ho AL, Ghajar J. Mild traumatic brain injury and concussion: terminology and classification. Handb Clin Neurol. 2018;158:21–4.CrossRefGoogle Scholar
  6. 6.
    Ryan LM, Warden DL. Post concussion syndrome. Int Rev Psychiatry. 2003;15(4):310–6.CrossRefGoogle Scholar
  7. 7.
    Levin HS, Diaz-Arrastia RR. Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol. 2015;14(5):506–17.CrossRefGoogle Scholar
  8. 8.
    McMahon PJ, Hricik A, Yue JK, Puccio AM, Inoue T, Lingsma HF, et al. Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma. 2014;31(1):26–33.CrossRefGoogle Scholar
  9. 9.
    Moran LM, Taylor HG, Rusin J, Bangert B, Dietrich A, Nuss KE, et al. Quality of life in pediatric mild traumatic brain injury and its relationship to postconcussive symptoms. J Pediatr Psychol. 2011;37(7):736–44.CrossRefGoogle Scholar
  10. 10.
    Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, et al. Surveillance for traumatic brain injury-related deaths: United States, 1997–2007. MMWR Surveill Summ. 2011;60(5):1–32.PubMedGoogle Scholar
  11. 11.
    Born K, Amsler F, Gross T. Prospective evaluation of the Quality of Life after Brain Injury (QOLIBRI) score: minor differences in patients with major versus no or mild traumatic brain injury at one-year follow up. Health Quality Life Outcomes. 2018;16(1):136.CrossRefGoogle Scholar
  12. 12.
    Messé A, Caplain S, Pélégrini-Issac M, Blancho S, Montreuil M, Lévy R, et al. Structural integrity and postconcussion syndrome in mild traumatic brain injury patients. Brain Imaging Behav. 2012;6(2):283–92.CrossRefGoogle Scholar
  13. 13.
    McDonald BC, Flashman LA, Saykin AJ. Executive dysfunction following traumatic brain injury: neural substrates and treatment strategies. NeuroRehabilitation. 2002;17(4):333–44.PubMedGoogle Scholar
  14. 14.
    Yousefzadeh-Chabok S, Ramezani S, Reihanian Z, Safaei M, Alijani B, Amini N. The role of early posttraumatic neuropsychological outcomes in the appearance of latter psychiatric disorders in adults with brain trauma. Asian J Neurosurg. 2015;10(3):173.CrossRefGoogle Scholar
  15. 15.
    Cossette I, Gagné M-È, Ouellet M-C, Fait P, Gagnon I, Sirois K, et al. Executive dysfunction following a mild traumatic brain injury revealed in early adolescence with locomotor-cognitive dual-tasks. Brain Inj. 2016;30(13–14):1648–55.CrossRefGoogle Scholar
  16. 16.
    Maillard-Wermelinger A, Yeates KO, Gerry Taylor H, Rusin J, Bangert B, Dietrich A, et al. Mild traumatic brain injury and executive functions in school-aged children. Dev Neurorehabil. 2009;12(5):330–41.CrossRefGoogle Scholar
  17. 17.
    Shinoda J, Asano Y. Disorder of executive function of the brain after head injury and mild traumatic brain injury-neuroimaging and diagnostic criteria for implementation of administrative support in Japan. Neurol Med Chir. 2017;57(5):199–209.CrossRefGoogle Scholar
  18. 18.
    Wood RL, Worthington A. Neurobehavioral abnormalities associated with executive dysfunction after traumatic brain injury. Front Behav Neurosci. 2017;11:195.CrossRefGoogle Scholar
  19. 19.
    Erez AB-H, Rothschild E, Katz N, Tuchner M, Hartman-Maeir A. Executive functioning, awareness, and participation in daily life after mild traumatic brain injury: a preliminary study. Am J Occup Ther. 2009;63(5):634.Google Scholar
  20. 20.
    Rengachary SS, Ellenbogen RG. Principles of neurosurgery. USA: Elsevier Mosby; 2005.Google Scholar
  21. 21.
    Yousefzade-Chabok S, Kapourchali SR, Reihanian Z, Leili EK, Moghadam AD, Amiri ZM. Predictors of chronic physical and mental quality of life following traumatic brain injury. Health. 2014;6(06):496.CrossRefGoogle Scholar
  22. 22.
    Chabok SY, Kapourchali SR, Leili EK, Saberi A, Mohtasham-Amiri Z. Effective factors on linguistic disorder during acute phase following traumatic brain injury in adults. Neuropsychologia. 2012;50(7):1444–500.CrossRefGoogle Scholar
  23. 23.
    Katz DI, Cohen SI, Alexander MP. Mild traumatic brain injury. Handb Clin Neurol. 2015;127:131–56.CrossRefGoogle Scholar
  24. 24.
    Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875–82.CrossRefGoogle Scholar
  25. 25.
    Bazarian JJ, Atabaki SM. Predicting post-concussive syndrome after minor head injury: a comparison of variables generated by logistic regression and recursive partitioning. Acad Emerg Med. 2000;7(5):504.Google Scholar
  26. 26.
    Prince C, Bruhns M. Evaluation and treatment of mild traumatic brain injury: the role of neuropsychology. Brain Sci. 2017;7(8):105.CrossRefGoogle Scholar
  27. 27.
    Hall RC, Hall RC, Chapman MJ. Definition, diagnosis, and forensic implications of postconcussional syndrome. Psychosomatics. 2005;46(3):195–202.CrossRefGoogle Scholar
  28. 28.
    Haydel M. Management of mild traumatic brain injury in the emergency. Emerg Med Pract. 2012;14(9):1–24.PubMedGoogle Scholar
  29. 29.
    Bales JW, Wagner AK, Kline AE, Dixon CE. Persistent cognitive dysfunction after traumatic brain injury: a dopamine hypothesis. Neurosci Biobehav Rev. 2009;33(7):981–1003.CrossRefGoogle Scholar
  30. 30.
    Lannsjö M, Backheden M, Johansson U. af Geijerstam J-L, Borg J, editors. Does head CT scan pathology predict outcome after mild traumatic brain injury? Brain Injury. 2013;20(1):124–9.Google Scholar
  31. 31.
    Faux S, Sheedy J, Delaney R, Riopelle R. Emergency department prediction of post-concussive syndrome following mild traumatic brain injury—an international cross-validation study. Brain Inj. 2011;25(1):14–22.CrossRefGoogle Scholar
  32. 32.
    Sheedy J, Harvey E, Faux S, Geffen G, Shores EA. Emergency department assessment of mild traumatic brain injury and the prediction of postconcussive symptoms: a 3-month prospective study. J Head Trauma rehabil. 2009;24(5):333–43.CrossRefGoogle Scholar
  33. 33.
    McCrea MA, Nelson LD, Guskiewicz K. Diagnosis and management of acute concussion. Phys Med Rehabil Clin. 2017;28(2):271–86.CrossRefGoogle Scholar
  34. 34.
    Foks KA, Cnossen MC, Dippel DW, Maas AI, Menon D, van der Naalt J, et al. Management of mild traumatic brain injury at the emergency department and hospital admission in Europe: a survey of 71 neurotrauma centers participating in the CENTER-TBI study. J Neurotrauma. 2017;34(17):2529–35.CrossRefGoogle Scholar
  35. 35.
    Powell JM, Ferraro JV, Dikmen SS, Temkin NR, Bell KR. Accuracy of mild traumatic brain injury diagnosis. Arch Phys Med Rehabil. 2008;89(8):1550–5.CrossRefGoogle Scholar
  36. 36.
    Jagoda AS, Bazarian JJ, Bruns JJ Jr, Cantrill SV, Gean AD, Howard PK, et al. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. J Emerg Nurs. 2009;35(2):e5–e40.CrossRefGoogle Scholar
  37. 37.
    Stuss DT. Traumatic brain injury: relation to executive dysfunction and the frontal lobes. Curr Opin Neurol. 2011;24(6):584–9.CrossRefGoogle Scholar
  38. 38.
    Niogi S, Mukherjee P, Ghajar J, Johnson C, Kolster R, Sarkar R, et al. Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion tensor imaging study of mild traumatic brain injury. Am J Neuroradiol. 2008;29(5):967–73.CrossRefGoogle Scholar
  39. 39.
    Metting Z, Rödiger LA, De Keyser J, van der Naalt J. Structural and functional neuroimaging in mild-to-moderate head injury. Lancet Neurol. 2007;6(8):699–710.CrossRefGoogle Scholar
  40. 40.
    Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT, Druzgal TJ, et al. Imaging evidence and recommendations for traumatic brain injury: conventional neuroimaging techniques. J Am Coll Radiol. 2015;12(2):e1–e14.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shahrokh Yousefzadeh-Chabok
    • 1
    • 2
  • Fatemeh Ramezani Kapourchali
    • 3
  • Sara Ramezani
    • 1
    • 2
    Email author
  1. 1.Neuroscience Research Center, School of MedicineGuilan University of Medical SciencesRashtIran
  2. 2.Guilan Road Trauma Research CenterGuilan University of Medical SciencesRashtIran
  3. 3.Department of Inflammation and ImmunityLerner Research Institute, Cleveland ClinicClevelandUSA

Personalised recommendations