Injury-Related and Personal Predictors of Persistent Neurobehavioral Symptoms in Adults with mTBI

Abstract

Research Objectives To determine predictors of persistent neurobehavioral symptoms1 in adults with mild traumatic brain injury (mTBI)/concussion. Design Cohort Study. Setting Concussion clinic. Participants Adults with concussion (n=146; n=90 (61.6%) women). Interventions Not Applicable. Main Outcome Measures Behavioral Assessment Screening Tool (BAST): measures frequency of neurobehavioral symptoms (1=never to 5=very often) in five domains at 3-months post-baseline: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse.2-5 Baseline factors included as independent variables in all predictive models were: previous head injury (Y/N), loss of consciousness (LOC) (Y/N), preinjury psychiatric diagnosis (Y/N), time since injury, and age at first concussion. Results We conducted five linear regressions (one for each BAST subscale). Models were significant for Negative Affect (R2Adj =.148, p < .001), Fatigue (R2Adj =.068, p =.012), and Executive Function (R2Adj =.090, p = .003). However, the model was not significant for Impulsivity (R2Adj =.024, p = .139) or Substance Abuse (R2Adj = -.010, p = .600). Impulsivity and Substance Abuse were both reported less frequently (M=1.76, SD=0.63 and M=1.13, SD=0.32, respectively) in this sample compared to Negative Affect (M=2.66, SD=0.73), Fatigue (M=2.96, SD=0.85), and Executive Function (M=2.09, SD=0.55). Preinjury psychiatric diagnoses (β=.307, p < .001) and age at first concussion (β=-.249, p=.005) were the strongest predictors of Negative Affect. Preinjury psychiatric diagnoses (β=.204, p=.015) and time since injury (β=.224, p=.009) were the strongest predictors of Fatigue. Age at first concussion (β=-.317, p=.001) was the strongest predictor of Executive Function. Conclusions Our research indicates that personal and injury-related factors are associated with persistent affective, fatigue, and cognitive symptoms, but not impulsivity or substance abuse. Identifying those at risk for persistent symptoms after mTBI/concussion at the time of their initial clinic visit could inform risk-stratified clinical surveillance and treatment planning. Author(s) Disclosures The authors report no conflicts of interest. To determine predictors of persistent neurobehavioral symptoms1 in adults with mild traumatic brain injury (mTBI)/concussion. Cohort Study. Concussion clinic. Adults with concussion (n=146; n=90 (61.6%) women). Not Applicable. Behavioral Assessment Screening Tool (BAST): measures frequency of neurobehavioral symptoms (1=never to 5=very often) in five domains at 3-months post-baseline: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse.2-5 Baseline factors included as independent variables in all predictive models were: previous head injury (Y/N), loss of consciousness (LOC) (Y/N), preinjury psychiatric diagnosis (Y/N), time since injury, and age at first concussion. We conducted five linear regressions (one for each BAST subscale). Models were significant for Negative Affect (R2Adj =.148, p < .001), Fatigue (R2Adj =.068, p =.012), and Executive Function (R2Adj =.090, p = .003). However, the model was not significant for Impulsivity (R2Adj =.024, p = .139) or Substance Abuse (R2Adj = -.010, p = .600). Impulsivity and Substance Abuse were both reported less frequently (M=1.76, SD=0.63 and M=1.13, SD=0.32, respectively) in this sample compared to Negative Affect (M=2.66, SD=0.73), Fatigue (M=2.96, SD=0.85), and Executive Function (M=2.09, SD=0.55). Preinjury psychiatric diagnoses (β=.307, p < .001) and age at first concussion (β=-.249, p=.005) were the strongest predictors of Negative Affect. Preinjury psychiatric diagnoses (β=.204, p=.015) and time since injury (β=.224, p=.009) were the strongest predictors of Fatigue. Age at first concussion (β=-.317, p=.001) was the strongest predictor of Executive Function. Our research indicates that personal and injury-related factors are associated with persistent affective, fatigue, and cognitive symptoms, but not impulsivity or substance abuse. Identifying those at risk for persistent symptoms after mTBI/concussion at the time of their initial clinic visit could inform risk-stratified clinical surveillance and treatment planning.