AUTHOR=Eagle Shawn R. , Jain Sonia , Sun Xiaoying , Preszler Jonathan , McCrea Michael A. , Giacino Joseph T. , Manley Geoffrey T. , Okonkwo David O. , Nelson Lindsay D. ,  The TRACK-TBI Investigators 

TITLE=Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1308540

DOI=10.3389/fneur.2023.1308540

ISSN=1664-2295

ABSTRACT=Introduction: Mild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI symptoms relate to each other.The centrality hypothesis of network theory posits that certain symptoms in a network are more relevant (central) or have above average influence over the rest of the network. However, no studies have used NA to characterize the interrelationships between symptoms in a cohort of patients who presented with mTBI to a U.S. Level 1 trauma center emergency department and how subacute central symptoms relate to long-term outcomes. Methods: Patients with mTBI (Glasgow Coma Scale=13-15) evaluated across 18 U.S. Level 1 trauma centers from 2013-2019 completed the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at two weeks (W2) post-injury (n=1,593) and at three months (M3), six months (M6), and twelve months (M12) post-injury. Network maps were developed from RPQ subscale scores at each timepoint. RPQ scores at W2 were associated with M6 and M12 functional and quality of life outcomes. Results: Network structure did not differ across timepoints, indicating no difference in symptoms/factors influence on the overall symptom network across time. The cognitive factor had the highest expected influence at W2 (1.761), M3 (1.245), and M6 (1.349). Fatigue had the highest expected influence at M12 (1.275). The emotional factor was the only other node with expected influence > 1 at any timepoint, indicating disproportionate influence of emotional symptoms on overall symptom burden (M3= 1.011; M6=1.076). Discussion: Several symptom factors at two-weeks post-injury were more strongly associated with incomplete recovery and/or poorer injury-related quality of life at six and twelve months post-injury than previously validated demographic and clinical covariates. The network analysis suggests that emotional, cognitive, and fatigue