Predictors of Postconcussive Symptoms 3 Months After Mild Traumatic Brain Injury

Monash University, Melbourne, Australia.
Neuropsychology (Impact Factor: 3.43). 04/2012; 26(3):304-13. DOI: 10.1037/a0027888
Source: PubMed

ABSTRACT There is continuing controversy regarding predictors of poor outcome following mild traumatic brain injury (mTBI). This study aimed to prospectively examine the influence of preinjury factors, injury-related factors, and postinjury factors on outcome following mTBI.
Participants were 123 patients with mTBI and 100 trauma patient controls recruited and assessed in the emergency department and followed up 1 week and 3 months postinjury. Outcome was measured in terms of reported postconcussional symptoms. Measures included the ImPACT Post-Concussional Symptom Scale and cognitive concussion battery, including Attention, Verbal and Visual memory, Processing Speed and Reaction Time modules, pre- and postinjury SF-36 and MINI Psychiatric status ratings, VAS Pain Inventory, Hospital Anxiety and Depression Scale, PTSD Checklist-Specific, and Revised Social Readjustment Scale.
Presence of mTBI predicted postconcussional symptoms 1 week postinjury, along with being female and premorbid psychiatric history, with elevated HADS anxiety a concurrent indicator. However, at 3 months, preinjury physical or psychiatric problems but not mTBI most strongly predicted continuing symptoms, with concurrent indicators including HADS anxiety, PTSD symptoms, other life stressors and pain. HADS anxiety and age predicted 3-month PCS in the mTBI group, whereas PTSD symptoms and other life stressors were most significant for the controls. Cognitive measures were not predictive of PCS at 1 week or 3 months.
Given the evident influence of both premorbid and concurrent psychiatric problems, especially anxiety, on postinjury symptoms, managing the anxiety response in vulnerable individuals with mTBI may be important to minimize ongoing sequelae.

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  • Psychological Injury and Law 09/2014; 7(3):245-254. DOI:10.1007/s12207-014-9201-3
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    ABSTRACT: The purpose of this study is to examine the relation between the microstructural architecture of white matter, as measured by diffusion tensor imaging (DTI), and postconcussion symptom reporting 6-8 weeks following mild traumatic brain injury (MTBI). Participants were 108 patients prospectively recruited from a Level 1 Trauma Center (Vancouver, BC, Canada) following an orthopedic injury [i.e., 36 trauma controls (TCs)] or MTBI (n = 72). DTI of the whole brain was undertaken using a Phillips 3T scanner at 6-8 weeks postinjury. Participants also completed a 5 h neurocognitive test battery and a brief battery of self-report measures (e.g., depression, anxiety, and postconcussion symptoms). The MTBI sample was divided into two groups based on ICD-10 criteria for postconcussional syndrome (PCS): first, PCS-present (n = 20) and second, PCS-absent (n = 52). There were no significant differences across the three groups (i.e., TC, PCS-present, and PCS-absent) for any of the neurocognitive measures (p = .138-.810). For the self-report measures, the PCS-present group reported significantly more anxiety and depression symptoms compared with the PCS-absent and TC groups (p < .001, d = 1.63-1.89, very large effect sizes). For the DTI measures, there were no significant differences in fractional anisotropy, axial diffusivity, radial diffusivity, or mean diffusivity when comparing the PCS-present and PCS-absent groups. However, there were significant differences (p < .05) in MD and RD when comparing the PCS-present and TC groups. There were significant differences in white matter between TC subjects and the PCS-present MTBI group, but not the PCS-absent MTBI group. Within the MTBI group, white-matter changes were not a significant predictor of ICD-10 PCS. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    Archives of Clinical Neuropsychology 11/2014; 30(1). DOI:10.1093/arclin/acu060 · 1.92 Impact Factor
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    ABSTRACT: Background: The objective of this study was to determine who gets post-concussion syndrome (PCS) after mild traumatic brain injury or head injury. Methods: Patients presented within an hour of mild traumatic brain injury (mTBI). Written informed consent was obtained from all patients, who then provided detailed answers to surveys at the time of injury as well as at 1 week and 1 month follow-up. Statistical analyses were performed using JMP 11.0 for the Macintosh. Results: The most commonly reported symptoms of PCS at first follow-up were headache (27%), trouble falling asleep (18%), fatigue (17%), difficulty remembering (16%), and dizziness (16%). Furthermore, only 61% of the cohort was driving at 1 week follow-up, compared to 100% prior to the injury. Linear regression analysis revealed the consumption of alcohol prior to head injury, the mechanism of head injury being a result of motor vehicle collision (MVC) or fall, and the presence of a post-injury headache to be significantly associated with developing PCS at 1 week follow-up, while the occurrence of a seizure post-injury or having an alteration in consciousness post-injury was significantly associated with developing PCS at 1 month follow-up. On multivariate regression analysis, the presence of a headache post-injury was the most robust predictor, retaining statistical significance even after controlling for age, gender, and presence of loss of consciousness (LOC), alteration of consciousness (AOC), post-traumatic amnesia (PTA), seizure, or vomiting. Conclusions: The results of this prospective study suggest that headache right after the head injury, an alteration of consciousness after the head injury, and alcohol consumption prior to the head injury are significant predictors of developing PCS, which occurs with equal frequency in men and women. Early identification of those who are at risk of developing PCS would diminish the burden of the injury and could potentially reduce the number of missed work and school days. Keywords: Post-concussion syndrome; Mild traumatic brain injury; Emergency department
    International Journal of Emergency Medicine 08/2014; 7:31. DOI:10.1186/s12245-014-0031-6


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Oct 27, 2014