Mild Traumatic Brain Injury: Determinants and Subsequent Quality of Life. A Review of the Literature.

Nutthita Petchprapai, PhD RN; Chris Winkelman, PhD RN ACNP CCRN


J Neurosci Nurs. 2007;39(5):260-272. 

In This Article

Abstract and Introduction

In this review, we analyzed literature related to the clinical, theoretical, and empirical determinants of mild traumatic brain injury (MTBI) in adults, with a focus on outcomes. Consequences after MTBI were summarized, patient outcomes were organized following Ferrans and Powers' conceptual model of quality of life, and gaps in knowledge were identified. The following databases were searched for publications related to MTBI: PubMed, PsycINFO, CINAHL, and Digital Dissertation. A total of 44 publications related to MTBI in adults were identified. Neither clinical nor theoretical definitions nor empirical descriptions agreed on the determinants of MTBI in adults. Nine reports included a holistic evaluation of outcomes after MTBI; an additional 35 studies examined health and functioning, psychological, or socioeconomic consequences. Results were mixed regarding how MTBI affects individuals in overall quality of life and which domains of quality of life are affected. With more than one million adults experiencing MTBI annually in the United States, it benefits the healthcare professional to understand the challenges of identifying adults who experience MTBI. Furthermore, the consequences of MTBI may be clinically important. Further research about MTBI using clear definitions and a holistic approach to recovery is warranted.

Mild traumatic brain injury (MTBI) affects more than one million individuals annually in the United States (National Center for Injury Prevention and Control, 2003). Worldwide, estimates of this phenomenon are more difficult to establish because the definitions of MTBI vary extensively in the clinical, theoretical, and empirical literature. Although a consensus panel identified key determinants of MTBI in 1992 (World Health Organization, 1992), this definition is not yet universally accepted. This uncertainty in definitions makes it difficult to capture the outcomes after MTBI. Published studies present conflicting findings that suggest the occurrence of consequences after MTBI may vary from nonexistent to frequently reported. Reported duration of symptoms ranged from a few minutes to prolonged derangement in health.

This article reviews the definitions of MTBI and presents findings related to outcomes after MTBI. The findings are framed from a holistic perspective, namely, quality of life. When studies did not explicitly examine quality of life, domains of quality of life from Ferrans and Powers' framework (Ferrans, 1996) were used to cluster results. Use of this framework is congruent with nursing's holistic approach to care and links the body of knowledge about recovery from MTBI to information from other healthcare disciplines. This review will help nurses and other healthcare professionals understand possible consequences that patients may experience after MTBI and will suggest future directions for research. Understanding MTBI determinants and outcomes is the necessary first step to developing interventions that target exemplary care for these patients.