Abstract
Objective: This study sought to explore whether subgroups of patients with mild TBI could be identified by their symptom profile according to cluster analysis. We also investigated whether these clusters are uniquely associated with structural brain damage as well as their relationship to anxiety and depression, other health complaints, functioning and participation in work. Methods: This was a prospective cohort study of patients with mild TBI who were registered at baseline and 6-8 weeks after injury. Results: A total of 270 patients were included. K-mean cluster analyses were conducted to describe groups of subjects with similar profiles of responses to the Rivermead Post Concussion Symptoms Questionnaire (RPQ). The four-cluster solution revealed one cluster with a low level of symptoms (low), one with a generally high symptom level (high), one cluster characterised by a high level of symptoms regarding cognitive functions (cognitive) and one cluster with somatic and frustration dominating symptoms (somatic). No significant differences in symptom level (mean score on RPQ) were revealed between subjects with and without radiological findings on brain scans (p=0.34). The “high” cluster group scored significantly higher than clusters 1, 2 and 3 in terms of both depression and anxiety but significantly lower on the GOSE. Cluster 2 scored significantly lower for health complaints in comparison to the other clusters. Conclusion: Subgroups of patients with mild TBI could be identified according to their symptom profile using cluster analysis. Patients with minor symptoms had a reduced risk for a positive finding on CT or MRI, whereas the high symptom level group struggled to return to work and demonstrated high levels of anxiety, depression and disability.
Highlights
Traumatic brain injury (TBI) is defined as brain injury caused by external trauma ranging from very severe injuries that can cause death and severe disability to minor but frequent injuries [1]
The four-cluster solution revealed one cluster with low symptoms, one cluster with a generally high symptom level, one cluster characterised by a high level of symptoms regarding cognitive functions and one cluster with dominating somatic and frustration symptoms (Table 5)
It has been difficult to predict recovery based on individual symptoms, which may be due to large interindividual differences in the severity of intracranial injury in mild TBI [38]
Summary
Traumatic brain injury (TBI) is defined as brain injury caused by external trauma ranging from very severe injuries that can cause death and severe disability to minor but frequent injuries [1]. Even when assessing the incidence of hospital-treated TBI in a neurosurgical department, 86% of all cases classified were defined as mild TBI [8], with the dominating long-term burden considered post-concussion symptoms [4]. The Rivermead Post Concussion Symptoms Questionnaire (RPQ) [18] is one of the instruments most frequently used to measure the change in symptoms from the preinjury level. The RPQ has been documented to predict functional outcome and disability [19], the ability of subjects to correctly remember their preinjury symptom level has been questioned [15], and the results of the RPQ for TBI patients can overlap with those of healthy subjects [16]. Subgroups of patients with specific symptom profiles are identified and further validated regarding the diagnostic or prognostic validity
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