Brain Injury, July 2006; 20(8): 799–806
Symptoms and disability until 3 months after mild TBI
A. LUNDIN1, C. DE BOUSSARD2, G. EDMAN1, & J. BORG3
1Department of Psychiatry,2Department of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital,
Stockholm, Sweden, and3Department of Neuroscience, Rehabilitation Medicine, Uppsala University Hospital,
(Received 13 July 2005; accepted 8 April 2006)
Objective: Examine frequency, character and course of symptoms until 3 months after MTBI and the relation between
symptoms and disability.
Methods: Prospective cohort study of 122 consecutive patients with MTBI. Symptom assessment after 1, 7 and 14 days and
3 months post-injury by use of Rivermead Post-concussional Questionnaire. Disability assessment by use of Rivermead
Head Injury Follow-up Questionnaire.
Results: Patients reporting one or more symptoms declined from 86% on day 1 to 49% 3 months post-injury, when 25% also
reported change in one or more domains of everyday activities. Poor memory, sleep disturbance and fatigue were most
commonly reported. Symptom and disability scores were correlated (? ¼0.60; p<0.001). Early symptom load correlated
with late symptom load (? ¼0.38; p<0.01).
Conclusions: Symptoms gradually decline post-injury. Symptoms correlate with disability at 3 months. Patients with early
high symptom load are at risk for developing persisting complaints.
Keywords: Mild TBI, symptoms, disability
Data on the prevalence, character and risk factors for
persisting symptoms and disability after mild trau-
matic brain injury (MTBI) are inconsistant [1, 2].
This might reflect variations with regard to study
settings and designs and probably explains the
currently weak evidence base for intervention to
prevent or treat persisting complaints [3, 4].
Almost all MTBI patients report symptoms
such as headache and forgetfulness in the early
phase after the injury [4, 5]. In the majority of
patients, these symptoms resolve within 3 months
[6, 7]. A sub-group of patients report persisting
symptoms at 3 months and later, such as head-
ache [5, 8–10], dizziness [8, 10], concentration
difficulties [5, 11, 12] and fatigue [5, 13, 14]. In
have occurred or exacerbated after the injury,
24–60% of MTBI patients report one or more
such symptoms at 3 months or later after the
injury [5, 10, 12]. Some of this variation is
probably relatedto methodological
inherent in studies of MTBI, such as different
case definitions, different outcome measures and
insufficient control of confounding factors .
The concept of a ‘post-concussional syndrome’,
used inmany reports
DSM-IV, has been questioned due to lack of
consistency of the symptom constellation , lack
of intervention data supporting a common under-
lying mechanism  and unspecificity of the
andthus assessingsymptoms that
Correspondence: Dr Anders Lundin, MD, Psychiatric clinic, R&D section, Karolinska Institutet, Danderyd Hospital, 182 87 Danderyd, Sweden.
Tel: 46-8-6555852. Fax: 46-8-7533421. E-mail: email@example.com
ISSN 0269–9052 print/ISSN 1362–301X online ? 2006 Informa UK Ltd.
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