Predictors of Postconcussive Symptoms 3 Months After Mild Traumatic Brain Injury

Monash University, Melbourne, Australia.
Neuropsychology (Impact Factor: 3.27). 04/2012; 26(3):304-13. DOI: 10.1037/a0027888
Source: PubMed


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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Available from: Antonina A Mikocka-Walus, Oct 27, 2014
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    • "ypical symptoms that may occur in the first weeks following an injury to help adapting the child ' s schedule and activities . Comprehensive informa - tion is not only important to prevent excessive physical and cognitive strains after the injury ( Sady et al . , 2011 ) , but also to minimize parental stress and optimize coping with the incident ( Ponsford et al . , 2001 ) . Although there were no post - acute neuropsychological or socio - behavioral differences between children after mTBI and OI , our findings indicate that current and pre - injury everyday attention problems were negatively associated with neuropsychological performance in children after mTBI . Thus , future research should focus on f"
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    ABSTRACT: Objective: There is evidence that children after mild traumatic brain injuries (mTBI) suffer ongoing post-concussive symptoms (PCS). However, results concerning neuropsychological outcome after mTBI are controversial. Thus, our aim was to examine group differences regarding neuropsychological outcome and PCS. Additionally, we explored the influence of current and pre-injury everyday attention problems on neuropsychological outcome in children after mTBI. Method: In a prospective short-term longitudinal study, 40 children (aged 6-16 years) after mTBI and 38 children after orthopedic injury (OI) underwent neuropsychological, socio-behavioral and PCS assessments in the acute stage and at 1 week, at 4 weeks, and 4 months after the injury. Results: Parents of children after mTBI observed significantly more PCS compared to parents of children after OI, especially in the acute stage. Our results revealed no neuropsychological or socio-behavioral differences over time between both groups. However, in children after mTBI, we found negative correlations between elevated levels of everyday attention problems and reduced neuropsychological performance. Furthermore, there was a negative influence of pre-injury everyday attention problems on neuropsychological performance in children after mTBI. Conclusion: In accordance with earlier studies, parents of children after mTBI initially observed significantly more PCS compared to parents of children after OI. There were no neuropsychological or socio-behavioral group differences between children after mTBI and OI in the post-acute period. However, our exploratory findings concerning the influence of everyday attention problems on neuropsychological outcome indicate that current and pre-injury everyday attention problems were negatively associated with neuropsychological performance in children after mTBI.
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    • "The SCAT2 represents a revision of the original SCAT and consists of three primary indexes: (a) a symptom inventory, (b) the SAC (McCrea, Kelly, & Randolph, 2000), and (c) a modified balance test based on the BESS (Guskiewicz, 2001). The symptom self-evaluation portion of the SCAT2 was similar to the previously established Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Postconcussion Symptom Inventory, which includes 22 commonly reported concussion symptoms (Ponsford et al., 2012). Only the number of symptoms reported contributed to the overall SCAT2 score, but the severity of the symptoms (on a scale of 0 ¼ none to 6 ¼ severe) are taken into account when evaluating athletes with postconcussion symptoms. "
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    • "Several factors, including age, psychiatric conditions, demographics, and secondary gain, have been associated with severity of neurobehavioral symptoms (Bazarian et al., 2010, 1999; Binder & Rohling, 1996; Iverson, Gaetz, Lovell, & Collins, 2004; Luis et al., 2003; Mooney & Speed, 2001; Mooney et al., 2005; Paniak, Reynolds, Toller-Lobe, et al., 2002; Ponsford et al., 2012; Suhr & Gunstad, 2002; Vanderploeg , Curtiss, Luis, & Salazar, 2007). However, many of these factors are likely to overlap within an individual, and as such, their relative importance remains unclear. "
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