Skip to main content
Top
Published in: Journal of Neurology 1/2021

Open Access 01-01-2021 | Central Nervous System Trauma | Original Communication

Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study

Authors: Nada Andelic, Cecilie Røe, Cathrine Brunborg, Marina Zeldovich, Marianne Løvstad, Daniel Løke, Ida M. Borgen, Daphne C. Voormolen, Emilie I. Howe, Marit V. Forslund, Hilde M. Dahl, Nicole von Steinbuechel, CENTER-TBI participants investigators

Published in: Journal of Neurology | Issue 1/2021

Login to get access

Abstract

Background

Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities.

Methods

Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subjective fatigue was measured by single item on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), administered at baseline, three and 6 months postinjury. Patients were categorized by clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU). Injury severity, preinjury somatic- and psychiatric conditions, depressive and sleep problems were registered at baseline. For prediction of fatigue changes, descriptive statistics and mixed effect logistic regression analysis are reported.

Results

Fatigue was experienced by 47% of patients at baseline, 48% at 3 months and 46% at 6 months. Patients admitted to ICU had a higher probability of experiencing fatigue than those in ER and ADM strata. Females and individuals with lower age, higher education, more severe intracranial injury, preinjury somatic and psychiatric conditions, sleep disturbance and feeling depressed postinjury had a higher probability of fatigue.

Conclusion

A high and stable frequency of fatigue was found during the first 6 months after TBI. Specific socio-demographic factors, comorbidities and injury severity characteristics were predictors of fatigue in this study.
Appendix
Available only for authorised users
Literature
1.
go back to reference Aaronson LS, Teel CS, Cassmeyer V, Neuberger GB, Pallikkathayil L, Pierce J, Press AN, Williams PD, Wingate A (1999) Defining and measuring fatigue. Image J Nurs Sch 31:45–50CrossRef Aaronson LS, Teel CS, Cassmeyer V, Neuberger GB, Pallikkathayil L, Pierce J, Press AN, Williams PD, Wingate A (1999) Defining and measuring fatigue. Image J Nurs Sch 31:45–50CrossRef
2.
go back to reference Baker SP, O'Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196CrossRef Baker SP, O'Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196CrossRef
3.
go back to reference Barker-Collo S, Theadom A, Starkey N, Kahan M, Jones K, Feigin V (2018) Factor structure of the Rivermead post-concussion symptoms questionnaire over the first year following mild traumatic brain injury. Brain Inj 32:453–458CrossRef Barker-Collo S, Theadom A, Starkey N, Kahan M, Jones K, Feigin V (2018) Factor structure of the Rivermead post-concussion symptoms questionnaire over the first year following mild traumatic brain injury. Brain Inj 32:453–458CrossRef
4.
go back to reference Beaulieu-Bonneau S, Ouellet MC (2017) Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates. Neuropsychol Rehabil 27:983–1001CrossRef Beaulieu-Bonneau S, Ouellet MC (2017) Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates. Neuropsychol Rehabil 27:983–1001CrossRef
5.
go back to reference Borgaro SR, Baker J, Wethe JV, Prigatano GP, Kwasnica C (2005) Subjective reports of fatigue during early recovery from traumatic brain injury. J Head Trauma Rehabil 20:416–425CrossRef Borgaro SR, Baker J, Wethe JV, Prigatano GP, Kwasnica C (2005) Subjective reports of fatigue during early recovery from traumatic brain injury. J Head Trauma Rehabil 20:416–425CrossRef
6.
go back to reference Cantor JB, Ashman T, Gordon W, Ginsberg A, Engmann C, Egan M, Spielman L, Dijkers M, Flanagan S (2008) Fatigue after traumatic brain injury and its impact on participation and quality of life. J Head Trauma Rehabil 23:41–51CrossRef Cantor JB, Ashman T, Gordon W, Ginsberg A, Engmann C, Egan M, Spielman L, Dijkers M, Flanagan S (2008) Fatigue after traumatic brain injury and its impact on participation and quality of life. J Head Trauma Rehabil 23:41–51CrossRef
7.
go back to reference Cantor JB, Bushnik T, Cicerone K, Dijkers MP, Gordon W, Hammond FM, Kolakowsky-Hayner SA, Lequerica A, Nguyen M, Spielman LA (2012) Insomnia, fatigue, and sleepiness in the first 2 years after traumatic brain injury: an NIDRR TBI model system module study. J Head Trauma Rehabil 27:E1–14CrossRef Cantor JB, Bushnik T, Cicerone K, Dijkers MP, Gordon W, Hammond FM, Kolakowsky-Hayner SA, Lequerica A, Nguyen M, Spielman LA (2012) Insomnia, fatigue, and sleepiness in the first 2 years after traumatic brain injury: an NIDRR TBI model system module study. J Head Trauma Rehabil 27:E1–14CrossRef
8.
go back to reference Clark AL, Sorg SF, Holiday K, Bigler ED, Bangen KJ, Evangelista ND, Bondi MW, Schiehser DM, Delano-Wood L (2018) Fatigue is associated with global and regional thalamic morphometry in veterans with a history of mild traumatic brain injury. J Head Trauma Rehabil 33:382–392PubMedPubMedCentral Clark AL, Sorg SF, Holiday K, Bigler ED, Bangen KJ, Evangelista ND, Bondi MW, Schiehser DM, Delano-Wood L (2018) Fatigue is associated with global and regional thalamic morphometry in veterans with a history of mild traumatic brain injury. J Head Trauma Rehabil 33:382–392PubMedPubMedCentral
9.
go back to reference Colantonio A, Harris JE, Ratcliff G, Chase S, Ellis K (2010) Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury. BMC Neurol 10:102CrossRef Colantonio A, Harris JE, Ratcliff G, Chase S, Ellis K (2010) Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury. BMC Neurol 10:102CrossRef
10.
go back to reference Crichton A, Anderson V, Oakley E, Greenham M, Hearps S, Delzoppo C, Beauchamp MH, Hutchison JS, Guerguerian AM, Boutis K, Babl FE (2018) Fatigue following traumatic brain injury in children and adolescents: a longitudinal follow-up 6 to 12 months after injury. J Head Trauma Rehabil 33:200–209CrossRef Crichton A, Anderson V, Oakley E, Greenham M, Hearps S, Delzoppo C, Beauchamp MH, Hutchison JS, Guerguerian AM, Boutis K, Babl FE (2018) Fatigue following traumatic brain injury in children and adolescents: a longitudinal follow-up 6 to 12 months after injury. J Head Trauma Rehabil 33:200–209CrossRef
11.
go back to reference Cutler DM, Lleras-Muney A (2010) Understanding differences in health behaviors by education. J Health Econ 29:1–28CrossRef Cutler DM, Lleras-Muney A (2010) Understanding differences in health behaviors by education. J Health Econ 29:1–28CrossRef
12.
go back to reference Englander J, Bushnik T, Oggins J, Katznelson L (2010) Fatigue after traumatic brain injury: association with neuroendocrine, sleep, depression and other factors. Brain Inj 24:1379–1388CrossRef Englander J, Bushnik T, Oggins J, Katznelson L (2010) Fatigue after traumatic brain injury: association with neuroendocrine, sleep, depression and other factors. Brain Inj 24:1379–1388CrossRef
13.
go back to reference Esbjörnsson E, Skoglund T, Sunnerhagen KS (2013) Fatigue, psychosocial adaptation and quality of life one year after traumatic brain injury and suspected traumatic axonal injury; evaluations of patients and relatives. A pilot study. J Rehabil Med in press Esbjörnsson E, Skoglund T, Sunnerhagen KS (2013) Fatigue, psychosocial adaptation and quality of life one year after traumatic brain injury and suspected traumatic axonal injury; evaluations of patients and relatives. A pilot study. J Rehabil Med in press
14.
go back to reference Farace E, Alves WM (2000) Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 93:539–545CrossRef Farace E, Alves WM (2000) Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 93:539–545CrossRef
15.
go back to reference Gennarelli TA, Wodzin E (2006) AIS 2005: a contemporary injury scale. Injury 37:1083–1091CrossRef Gennarelli TA, Wodzin E (2006) AIS 2005: a contemporary injury scale. Injury 37:1083–1091CrossRef
16.
go back to reference Juengst SB, Nabasny A, Terhorst L (2019) Neurobehavioral symptoms in community-dwelling adults with and without chronic traumatic brain injury: differences by age, gender, education, and health condition. Front Neurol 10:1210CrossRef Juengst SB, Nabasny A, Terhorst L (2019) Neurobehavioral symptoms in community-dwelling adults with and without chronic traumatic brain injury: differences by age, gender, education, and health condition. Front Neurol 10:1210CrossRef
17.
go back to reference King NS, Crawford S, Wenden FJ, Moss NE, Wade DT (1995) The Rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 242(9):587–592CrossRef King NS, Crawford S, Wenden FJ, Moss NE, Wade DT (1995) The Rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 242(9):587–592CrossRef
18.
go back to reference Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123CrossRef Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123CrossRef
19.
go back to reference Lannsjo M, Borg J, Bjorklund G, Af Geijerstam JL, Lundgren-Nilsson A (2011) Internal construct validity of the Rivermead post-concussion symptoms questionnaire. J Rehabil Med 43:997–1002CrossRef Lannsjo M, Borg J, Bjorklund G, Af Geijerstam JL, Lundgren-Nilsson A (2011) Internal construct validity of the Rivermead post-concussion symptoms questionnaire. J Rehabil Med 43:997–1002CrossRef
20.
go back to reference Lerdal A, Bakken LN, Rasmussen EF, Beiermann C, Ryen S, Pynten S, Drefvelin AS, Dahl AM, Rognstad G, Finset A, Lee KA, Kim HS (2011) Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke. Disabil Rehabil 33:334–342CrossRef Lerdal A, Bakken LN, Rasmussen EF, Beiermann C, Ryen S, Pynten S, Drefvelin AS, Dahl AM, Rognstad G, Finset A, Lee KA, Kim HS (2011) Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke. Disabil Rehabil 33:334–342CrossRef
21.
go back to reference Lerdal A, Wahl A, Rustoen T, Hanestad BR, Moum T (2005) Fatigue in the general population: a translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scand J Public Health 33:123–130CrossRef Lerdal A, Wahl A, Rustoen T, Hanestad BR, Moum T (2005) Fatigue in the general population: a translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scand J Public Health 33:123–130CrossRef
22.
go back to reference Maas AI, Menon DK, Steyerberg EW, Citerio G, Lecky F, Manley GT, Hill S, Legrand V, Sorgner A (2015) Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery 76:67–80CrossRef Maas AI, Menon DK, Steyerberg EW, Citerio G, Lecky F, Manley GT, Hill S, Legrand V, Sorgner A (2015) Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery 76:67–80CrossRef
23.
go back to reference Mayhew D, Mendonca V, Murthy BVS (2019) A review of ASA physical status—historical perspectives and modern developments. Anaesthesia 74:373–379CrossRef Mayhew D, Mendonca V, Murthy BVS (2019) A review of ASA physical status—historical perspectives and modern developments. Anaesthesia 74:373–379CrossRef
24.
go back to reference Mollayeva T, Kendzerska T, Mollayeva S, Shapiro CM, Colantonio A, Cassidy JD (2014) A systematic review of fatigue in patients with traumatic brain injury: the course, predictors and consequences. Neurosci Biobehav Rev 47:684–716CrossRef Mollayeva T, Kendzerska T, Mollayeva S, Shapiro CM, Colantonio A, Cassidy JD (2014) A systematic review of fatigue in patients with traumatic brain injury: the course, predictors and consequences. Neurosci Biobehav Rev 47:684–716CrossRef
25.
go back to reference Niemeier JP, Perrin PB, Holcomb MG, Rolston CD, Artman LK, Lu J, Nersessova KS (2014) Gender differences in awareness and outcomes during acute traumatic brain injury recovery. J Womens Health (Larchmt ) 23:573–580CrossRef Niemeier JP, Perrin PB, Holcomb MG, Rolston CD, Artman LK, Lu J, Nersessova KS (2014) Gender differences in awareness and outcomes during acute traumatic brain injury recovery. J Womens Health (Larchmt ) 23:573–580CrossRef
26.
go back to reference Nordin LE, Moller MC, Julin P, Bartfai A, Hashim F, Li TQ (2016) Post mTBI fatigue is associated with abnormal brain functional connectivity. Sci Rep 6:21183CrossRef Nordin LE, Moller MC, Julin P, Bartfai A, Hashim F, Li TQ (2016) Post mTBI fatigue is associated with abnormal brain functional connectivity. Sci Rep 6:21183CrossRef
27.
go back to reference Norrie J, Heitger M, Leathem J, Anderson T, Jones R, Flett R (2010) Mild traumatic brain injury and fatigue: a prospective longitudinal study. Brain Inj 24:1528–1538CrossRef Norrie J, Heitger M, Leathem J, Anderson T, Jones R, Flett R (2010) Mild traumatic brain injury and fatigue: a prospective longitudinal study. Brain Inj 24:1528–1538CrossRef
28.
go back to reference Ouellet MC, Morin CM (2006) Fatigue following traumatic brain injury: Frequency, characteristics, and associated factors. Rehabil Psychol 51:140–148CrossRef Ouellet MC, Morin CM (2006) Fatigue following traumatic brain injury: Frequency, characteristics, and associated factors. Rehabil Psychol 51:140–148CrossRef
29.
go back to reference Ponsford J, Schonberger M, Rajaratnam SM (2015) A model of fatigue following traumatic brain injury. J Head Trauma Rehabil 30:277–282CrossRef Ponsford J, Schonberger M, Rajaratnam SM (2015) A model of fatigue following traumatic brain injury. J Head Trauma Rehabil 30:277–282CrossRef
30.
go back to reference Ponsford JL, Ziino C, Parcell DL, Shekleton JA, Roper M, Redman JR, Phipps-Nelson J, Rajaratnam SM (2012) Fatigue and sleep disturbance following traumatic brain injury–their nature, causes, and potential treatments. J Head Trauma Rehabil 27:224–233CrossRef Ponsford JL, Ziino C, Parcell DL, Shekleton JA, Roper M, Redman JR, Phipps-Nelson J, Rajaratnam SM (2012) Fatigue and sleep disturbance following traumatic brain injury–their nature, causes, and potential treatments. J Head Trauma Rehabil 27:224–233CrossRef
31.
go back to reference Potter S, Leigh E, Wade D, Fleminger S (2006) The Rivermead post concussion symptoms questionnaire: a confirmatory factor analysis. J Neurol 253:1603–1614CrossRef Potter S, Leigh E, Wade D, Fleminger S (2006) The Rivermead post concussion symptoms questionnaire: a confirmatory factor analysis. J Neurol 253:1603–1614CrossRef
32.
go back to reference Royston P (2004) Multiple imputation of missing values. Stata J227–241 Royston P (2004) Multiple imputation of missing values. Stata J227–241
33.
go back to reference Schiehser DM, Delano-Wood L, Jak AJ, Hanson KL, Sorg SF, Orff H, Clark AL (2017) Predictors of cognitive and physical fatigue in post-acute mild-moderate traumatic brain injury. Neuropsychol Rehabil 27:1031–1046CrossRef Schiehser DM, Delano-Wood L, Jak AJ, Hanson KL, Sorg SF, Orff H, Clark AL (2017) Predictors of cognitive and physical fatigue in post-acute mild-moderate traumatic brain injury. Neuropsychol Rehabil 27:1031–1046CrossRef
34.
go back to reference Steyerberg EW, Wiegers E, Sewalt C, Buki A, Citerio G, De Keyser V, Ercole A, Kunzmann K, Lanyon L, Lecky F, Lingsma H, Manley G, Nelson D, Peul W, Stocchetti N, Von SN, Vande VT, Verheyden J, Wilson L, Maas AIR, Menon DK (2019) Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol 18:923–934CrossRef Steyerberg EW, Wiegers E, Sewalt C, Buki A, Citerio G, De Keyser V, Ercole A, Kunzmann K, Lanyon L, Lecky F, Lingsma H, Manley G, Nelson D, Peul W, Stocchetti N, Von SN, Vande VT, Verheyden J, Wilson L, Maas AIR, Menon DK (2019) Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol 18:923–934CrossRef
35.
go back to reference Stulemeijer M, van der Werf S, Bleijenberg G, Biert J, Brauer J, Vos PE (2006) Recovery from mild traumatic brain injury: a focus on fatigue. J Neurol 253(8):1041–1047CrossRef Stulemeijer M, van der Werf S, Bleijenberg G, Biert J, Brauer J, Vos PE (2006) Recovery from mild traumatic brain injury: a focus on fatigue. J Neurol 253(8):1041–1047CrossRef
36.
go back to reference Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84CrossRef Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84CrossRef
37.
go back to reference Voormolen DC, Cnossen MC, Polinder S, Gravesteijn BY, von Steinbuechel N, Real RGL, Haagsma JA (2019) Prevalence of post-concussion-like symptoms in the general population in Italy, The Netherlands and the United Kingdom. Brain Inj 33:1078–1086CrossRef Voormolen DC, Cnossen MC, Polinder S, Gravesteijn BY, von Steinbuechel N, Real RGL, Haagsma JA (2019) Prevalence of post-concussion-like symptoms in the general population in Italy, The Netherlands and the United Kingdom. Brain Inj 33:1078–1086CrossRef
38.
go back to reference Voormolen DC, Cnossen MC, Polinder S, von Steinbuechel N, Vos PE, Haagsma JA (2018) Divergent classification methods of post-concussion syndrome after mild traumatic brain injury: prevalence rates, risk factors, and functional outcome. J Neurotrauma 35:1233–1241CrossRef Voormolen DC, Cnossen MC, Polinder S, von Steinbuechel N, Vos PE, Haagsma JA (2018) Divergent classification methods of post-concussion syndrome after mild traumatic brain injury: prevalence rates, risk factors, and functional outcome. J Neurotrauma 35:1233–1241CrossRef
39.
go back to reference Voormolen DC, Haagsma JA, Polinder S, Maas AIR, Steyerberg EW, Vulekovic P, Sewalt CA, Gravesteijn BY, Covic A, Andelic N, Plass AM, von Steinbuechel N (2019) Post-concussion symptoms in complicated vs uncomplicated mild traumatic brain injury patients at three and six months post-injury: results from the CENTER-TBI Study. J Clin Med 8:1921CrossRef Voormolen DC, Haagsma JA, Polinder S, Maas AIR, Steyerberg EW, Vulekovic P, Sewalt CA, Gravesteijn BY, Covic A, Andelic N, Plass AM, von Steinbuechel N (2019) Post-concussion symptoms in complicated vs uncomplicated mild traumatic brain injury patients at three and six months post-injury: results from the CENTER-TBI Study. J Clin Med 8:1921CrossRef
40.
go back to reference Whitehead L (2009) The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures. J Pain Symptom Manage 37:107–128CrossRef Whitehead L (2009) The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures. J Pain Symptom Manage 37:107–128CrossRef
41.
go back to reference Ziino C, Ponsford J (2005) Measurement and prediction of subjective fatigue following traumatic brain injury. J Int Neuropsychol Soc 11:416–425CrossRef Ziino C, Ponsford J (2005) Measurement and prediction of subjective fatigue following traumatic brain injury. J Int Neuropsychol Soc 11:416–425CrossRef
Metadata
Title
Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study
Authors
Nada Andelic
Cecilie Røe
Cathrine Brunborg
Marina Zeldovich
Marianne Løvstad
Daniel Løke
Ida M. Borgen
Daphne C. Voormolen
Emilie I. Howe
Marit V. Forslund
Hilde M. Dahl
Nicole von Steinbuechel
CENTER-TBI participants investigators
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 1/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-10022-2

Other articles of this Issue 1/2021

Journal of Neurology 1/2021 Go to the issue