IMPORTANCE Mild traumatic brain injury (mTBI) may impair the ability to work. Strategies to
facilitate return to work are understudied.
OBJECTIVE To assess employment and economic outcomes for employed, working-age adults with
mTBI in the 12 months after injury and the association between return to work and employer
assistance.
DESIGN, SETTING, AND PARTICIPANTS Using data from the Transforming Research and Clinical
Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a cohort study of patients with mTBI
presenting to emergency departments of 11 level I US trauma centers was performed. Patients with
mTBI enrolled in the TRACK-TBI cohort study from February 26, 2014, toMay 4, 2016, were followed
up at 2 weeks and 3, 6, and 12 months after injury.Work status and income decline of participants
were documented in the first year after injury. Associations between work status, injury
characteristics, and offer of employer assistance and associations between follow-up care and
employer assistance were investigated. Results were adjusted for unobserved outcomes using
inverse probability weighting. Data were extracted July 12, 2020; analyses were completed March
24, 2021. Analyses included 435 participants aged 18 to 64 years whowereworking before the injury,
had a Glasgow Coma Scale score of 13 to 15, and completed all postinjury follow-up surveys.
MAIN OUTCOMES AND MEASURES Primary outcomes were work status (working or not working)
at each study follow-up milestone. Employer assistance included sick leave, reduced hours, modified
schedule, transfer to different tasks, assistive technology, and coaching offered during the first 3
months after injury.
RESULTS Of 435 participants (147 [34%] female; 320 [74%] White; mean [SD] age 37.3 [12.9] years),
258 (59%) reported not working at 2 weeks after injury and 74 (17%) reported not working at 12
months after injury. More than one-fifth (92 [21%]) experienced a decline in annual income.Work
status at 12 months was significantly associated with postconcussion symptoms experienced at 3
months after injury (73%of patients with 3 or more symptoms reported working at 12 months after
injury vs 89% of patients with 2 or fewer symptoms; P < .001) but not with other injury
characteristics. Participants offered employer assistance in the first 3 months after injury were more
likely to report working after injury than those not offered such assistance (at 6 months: 88%vs
78%; P = .02; at 12 months: 86%vs 72%; P = .005).
CONCLUSIONS AND RELEVANCE In this cohort study, mTBI was associated with substantial
employment and economic consequences for some patients. Clinicians should systematically follow
up with patients with mTBI and coordinate with employers to promote successful return to work.