Post-Concussion Symptoms in Complicated vs. Uncomplicated Mild Traumatic Brain Injury Patients at Three and Six Months Post-Injury: Results from the CENTER-TBI Study.

Daphne C Voormolen,Anne Marie Plass,Juanita A Haagsma,Charlie A Sewalt,Benjamin Y Gravesteijn,Petar Vuleković,Suzanne Polinder,Andrew I.R Maas,Andrew I.R Maas,Ewout W Steyerberg,Ewout W Steyerberg,Nicole Von Steinbuechel,Nada Andelic,Amra Covic

doi:10.3390/jcm8111921

Abstract

The aim of this study was to assess the occurrence of post-concussion symptoms and post-concussion syndrome (PCS) in a large cohort of patients after complicated and uncomplicated mild traumatic brain injury (mTBI) at three and six months post-injury. Patients were included through the prospective cohort study: Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI). Patients enrolled with mTBI (Glasgow Coma Scale 13–15) were further differentiated into complicated and uncomplicated mTBI based on the presence or absence of computed tomography abnormalities, respectively. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) assessed post-concussion symptoms and PCS according to the mapped ICD-10 classification method. The occurrence of post-concussion symptoms and syndrome at both time points was calculated. Chi square tests were used to test for differences between and within groups. Logistic regression was performed to analyse the association between complicated versus uncomplicated mTBI and the prevalence of PCS. Patients after complicated mTBI reported slightly more post-concussion symptoms compared to those after uncomplicated mTBI. A higher percentage of patients after complicated mTBI were classified as having PCS at three (complicated: 46% vs. uncomplicated: 35%) and six months (complicated: 43% vs. uncomplicated 34%). After adjusting for baseline covariates, the effect of complicated versus uncomplicated mTBI at three months appeared minimal: odds ratio 1.25 (95% confidence interval: 0.95–1.66). Although patients after complicated mTBI report slightly more post-concussion symptoms and show higher PCS rates compared to those after uncomplicated mTBI at three and six months, complicated mTBI was only found a weak indicator for these problems.

Highlights

In the European Union, around 2.5 million new cases of traumatic brain injury (TBI) occur each year [1]
Within CENTER-TBI, most patients were classified as mild TBI (mTBI) (N = 2955; 65.5%), and these patients constituted the vast majority of patients in the emergency room (ER) (97%) and admission (93%) strata, but were present in the intensive care unit (ICU) (34%) stratum (Table 1)
A larger number of patients with complicated mTBI were found in the admission and ICU strata compared to the ER stratum

Summary

Introduction

In the European Union, around 2.5 million new cases of traumatic brain injury (TBI) occur each year [1]. The vast majority of patients presenting to hospital with a TBI are diagnosed as having mild TBI (mTBI; Glasgow Coma Score (GCS): 13–15) [1] Some of these patients may have traumatic intracranial abnormalities on the computed tomography (CT) performed on presentation which could potentially be associated with worse outcomes compared to those who do not have any traumatic intracranial abnormalities. For this reason, Williams et al [2] addressed a subgroup conceptualization of these injuries, which has been shown to provide more detail on level of outcome [3]. PCS has been a critically debated topic and the question has been raised if we can, or even should, identify this as a unique syndrome for TBI [4,5,11,12], the concept is still used in the majority of post-concussion symptom research

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