The Association of Post-Concussion and Post-Traumatic Stress Disorder Symptoms with Health-Related Quality of Life, Health Care Use and Return-to-Work after Mild Traumatic Brain Injury.

Marjolein Van Der Vlegel,Nicole Von Steinbuechel,Isabelle Mueller,Rana Kaplan,Katrin Cunitz,Anne Plass,Ana Mikolic,Fabian Bockhop,The Center-Tbi Participants And Investigators ,Marina Zeldovich,Dominique Van Praag,Suzanne Polinder,Juanita Haagsma

doi:10.3390/jcm10112473

Abstract

Patients with mild traumatic brain injury (mTBI) are at risk for post-concussion (PC) symptoms and post-traumatic stress disorder (PTSD). The co-occurrence of PC and PTSD symptoms after mTBI in relation to health-related quality of life (HRQoL), health care utilization, and return to work has not yet been investigated. PC and PTSD symptoms were measured six months post-TBI by respectively the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). Of the 1566 individuals after mTBI who met the inclusion criteria, 26.1% experienced PC symptoms (RPQ ≥16). Additionally, 9.8% experienced PTSD symptoms (PCL-5 ≥ 33), of which the vast majority (81%) also reported experiencing PC symptoms. Differences between patients with no/mild symptoms, with only PC, only PTSD, and both PC and PTSD symptoms in HRQoL, return to work, and rehabilitation were analyzed using logistic and linear regression analyses. Patients with PC and/or PTSD symptoms reported lower HRQoL, higher rates of rehabilitation, and lower return to work rates compared to patients with no/mild symptoms. Patients with both PC and PTSD symptoms reported significantly lower HRQoL (B = −2.73, CI = −4.65; −0.83, p < 0.001) compared to those with only PC symptoms, while there were no significant differences in their ongoing rehabilitation care (OR = 1.39, CI = 0.77–2.49, p = 0.272) and return to work rates (OR = 0.49, CI = 0.15–1.63, p = 0.246) at six months. These results underline the importance of the diagnosis and appropriate treatment of patients with mTBI, experiencing PC and/or PTSD symptoms.

Highlights

Traumatic brain injury (TBI) is an important public health problem with more than 50 million yearly cases worldwide [1]
Patients with severe PC symptoms were more often admitted to the intensive care unit (ICU) (37.0%) and had the highest Injury Severity Score (ISS) compared to the other groups
At the six-month follow-up, 60.1% of patients with no/mild symptoms had good recovery (GOSE score 8) compared to 13.4% of patients with only severe PC symptoms, 16.1% of patients with severe PC and posttraumatic stress disorder (PTSD) symptoms, and 27.6% of patients with only PTSD symptoms (p < 0.001)

Summary

Introduction

Traumatic brain injury (TBI) is an important public health problem with more than 50 million yearly cases worldwide [1]. It can be defined as ‘an alteration in brain function, or other evidence of brain pathology, caused by an external force’ [2]. Patients with mTBI can suffer from various post-concussion (PC) symptoms and in some cases, these symptoms can persist for months [5,6,7,8]. After mild TBI in the civilian setting, approximately 14% have PTSD [10] These symptoms can be differentiated into four symptom groups: intrusion/re-experiencing, avoidance, negative alterations in cognition and mood, and increased arousal/reactivity.

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