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Comment & Response
December 30, 2019

The Term Traumatic in Mild Traumatic Brain Injury and the Misrepresentation of Outcomes—Reply

Author Affiliations
  • 1Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
  • 2Departments of Physical Medicine, Neurology, Neurosurgery and Pediatrics, Baylor College of Medicine, Houston, Texas
JAMA Neurol. 2020;77(2):264-265. doi:10.1001/jamaneurol.2019.4457

In Reply We recently reported that many patients who presented to level 1 trauma centers after mild traumatic brain injury (mTBI) continued to report injury-related functional limitations at 1 year postinjury.1 Our findings are from the TRACK-TBI study, one of the most comprehensive prospective investigations of civilian TBI to date. A recent Letter to the Editor suggested that our findings veer from seminal work by several of our coauthors that was published 20 or more years ago. We contend that our results reflect major advances in brain injury science over the past 2 decades, including our understanding of mTBI. Levin et al2 and Dikmen et al3 focused on cognitive outcomes, not functional limitations, and analyzed narrower and broader TBI populations, respectively. Accordingly, they were not directly informative to cite in the present study. Our findings should also not be considered interchangeable with the research from McCrea et al4 on athletes with sport-related concussion. Factors, such as preinjury physical conditioning5 and TBI severity,3 are associated with recovery after mTBI; consequently, we should not assume that the rapid recovery experienced by most healthy athletes with sport-related concussion is generalizable to expected recovery in the broader neurotrauma population.

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