Poster 71: Characteristics of a Mild Head Injury Sub-Group with Extreme, Persisting Distress on the Rivermead Postconcussion Symptoms Questionnaire

Abstract

Objective: To identify distinctive baseline characteristics of participants with extreme reported symptoms (ie, outliers) 12 months after mild head injury (MHI). Design: Prospective cohort study of MHI with and without loss of consciousness (LOC) and/or posttraumatic amnesia (PTA) recruited at the emergency department (ED), with a follow-up telephone interview at 12 months. Setting: Level II community hospital ED. Participants: 58 participants with MHI and LOC≤30 minutes and/or PTA<24 hours and 173 with MHI but no PTA/LOC. Inclusion criteria: age ≥18; <24 hours after injury; Glasgow Coma Scale score ≥13; discharge from the ED. 14 participants had Rivermead Postconcussion Symptoms Questionnaire (RPQ) scores 2SD above sample mean. Interventions: Not applicable. Main Outcome Measures: RPQ; questions about health services utilization and litigation. Results: Characterizing outlier cases were preinjury disability, history of substance use, unemployment, previous head injury. At 12 months, outliers had higher health services utilization and litigation. Conclusions: The existence of a subgroup with distinctive baseline characteristics, independent of injury, suggests that taxonomic distinctions, with targeted interventions, are warranted for the MHI population. Exclusion of certain taxonomic subgroups is critical for research addressing diagnostic MHI characteristics.