326 Concussion Subtype Symptomatology in Complicated Mild Traumatic Brain Injury Patients

Abstract

INTRODUCTION: Post-concussive symptom scales (PCSS) can help discern recently defined concussion subtypes such as cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood with concussion-associated sleep disturbance and cervical strain. However, there is limited knowledge as to the utility of using subtype symptomatology in the assessment of complicated mild traumatic brain injury (TBI) patients. METHODS: We included mild TBI patients who presented to a neurosurgery TBI clinic and had completed a Rivermead Post Concussion Questionnaire (RPQ). Patient demographic factors such as age, sex, mechanism of injury, and arrival GCS were extracted from the medical record. Patients were characterized into groups based on imaging findings including epidural and subdural hematomas (extra-axial), or intraparenchymal, subarachnoid, or intraventricular blood (intra-axial) or both. We excluded patients with negative head CT results. We used the RPQ itemized questions to define symptom subtypes. Differences between groups were analyzed using an ANOVA and general linear model analysis in SPSS. RESULTS: We included a total of 163 patients, 52 showed intra-axial bleeds, 40 showed extra-axial bleeds, and 71 exhibited both intra- and extra-axial bleeds. ANOVA results show statistically significant differences in ocular-motor (p = 0.035), headache/migraine (p = 0.010), and vestibular (p = 0.032) subtype scores between groups. Specifically, multiple comparisons revealed the extra-axial means were lower in the ocular-motor (0.947 ± 0.235 SEM vs. 2.13 ± 0.312; p = 0.011), headache/migraine (1.50 ± 0.310 vs. 2.79 ± 0.258; p=0.003), and vestibular (1.18 ± 0.226 vs. 2.09 ± 0.198; p = 0.011) subtypes. Further analysis to determine the effects of several covariates found that age contributed significantly to the associated condition of sleep disturbance (p=0.049). CONCLUSION: Patients with complicated mild TBI have post-injury symptoms that can be classified into concussion subtypes. Patients with extra-axial bleeds exhibited consistently better subtype scores compared to those with intra-axial bleeds. Understanding subtype symptomatology may allow for subtype directed therapy to improve symptom recovery for mild TBI patients.