British Columbia Postconcussion Symptom Inventory Research Articles

Longitudinal Associations Between Persistent Post-Concussion Symptoms and Blood Biomarkers of Inflammation and CNS-Injury After Mild Traumatic Brain Injury.

The aim of our study was to investigate the biological underpinnings of persistent post-concussion symptoms (PPCS) at 3 months following mild traumatic brain injury (mTBI). Patients (n = 192, age 16-60 years) with mTBI, defined as Glasgow Coma Scale (GCS) score between 13 and 15, loss of consciousness (LOC) <30 min, and post-traumatic amnesia (PTA) <24 h were included. Blood samples were collected at admission (within 72 h), 2 weeks, and 3 months. Concentrations of blood biomarkers associated with central nervous system (CNS) damage (glial fibrillary acidic protein [GFAP], neurofilament light [NFL], and tau) and inflammation (interferon gamma [IFNγ], interleukin [IL]-8, eotaxin, macrophage inflammatory protein-1-beta [MIP]-1β, monocyte chemoattractant protein [MCP]-1, interferon-gamma-inducible protein [IP]-10, IL-17A, IL-9, tumor necrosis factor [TNF], basic fibroblast growth factor [FGF]-basic platelet-derived growth factor [PDGF], and IL-1 receptor antagonist [IL-1ra]) were obtained. Demographic and injury-related factors investigated were age, sex, GCS score, LOC, PTA duration, traumatic intracranial finding on magnetic resonance imaging (MRI; within 72 h), and extracranial injuries. Delta values, that is, time-point differences in biomarker concentrations between 2 weeks minus admission and 3 months minus admission, were also calculated. PPCS was assessed with the British Columbia Post-Concussion Symptom Inventory (BC-PSI). In single variable analyses, longer PTA duration and a higher proportion of intracranial findings on MRI were found in the PPCS group, but no single biomarker differentiated those with PPCS from those without. In multi-variable models, female sex, longer PTA duration, MRI findings, and lower GCS scores were associated with increased risk of PPCS. Inflammation markers, but not GFAP, NFL, or tau, were associated with PPCS. At admission, higher concentrations of IL-8 and IL-9 and lower concentrations of TNF, IL-17a, and MCP-1 were associated with greater likelihood of PPCS; at 2 weeks, higher IL-8 and lower IFNγ were associated with PPCS; at 3 months, higher PDGF was associated with PPCS. Higher delta values of PDGF, IL-17A, and FGF-basic at 2 weeks compared with admission, MCP-1 at 3 months compared with admission, and TNF at 2 weeks and 3 months compared with admission were associated with greater likelihood of PPCS. Higher IL-9 delta values at both time-point comparisons were negatively associated with PPCS. Discriminability of individual CNS-injury and inflammation biomarkers for PPCS was around chance level, whereas the optimal combination of biomarkers yielded areas under the curve (AUCs) between 0.62 and 0.73. We demonstrate a role of biological factors on PPCS, including both positive and negative effects of inflammation biomarkers that differed based on sampling time-point after mTBI. PPCS was associated more with acute inflammatory processes, rather than ongoing inflammation or CNS-injury biomarkers. However, the modest discriminative ability of the models suggests other factors are more important in the development of PPCS.

Trajectories of Persistent Postconcussion Symptoms and Factors Associated With Symptom Reporting After Mild Traumatic Brain Injury

ObjectiveTo examine the trajectories of persistent postconcussion symptoms (PPCS) after mild traumatic brain injury (MTBI) and to investigate which injury-related and personal factors are associated with symptom reporting. DesignProspective longitudinal cohort study. Follow-up at 3 and 12 months postinjury. SettingA level 1 trauma center and an emergency outpatient clinic. ParticipantsPatients with MTBI (n=358), trauma controls (n=75), and community controls (n=78). Main outcome measuresSymptoms were assessed with the British Columbia Postconcussion Symptom Inventory (BC-PSI). Participants were categorized as having moderate to severe PPCS (msPPCS) when reporting ≥3 moderate/severe symptoms or a BC-PSI total score of ≥13. BC-PSI total scores were compared between the groups and were further used to create cutoffs for reliable change by identifying uncommon and very uncommon change in symptoms in the community control group. Associations between symptom reporting and 25 injury-related and personal factors were examined. ResultsThe MTBI group had a similar prevalence of msPPCS at 3 and 12 months (21%) and reported more symptoms than the control groups. Analyses of individual trajectories, however, revealed considerable change in both msPPCS and BC-PSI total scores in the MTBI group, where both worsening and improvement was common. Intracranial lesions on computed tomography were associated with a greater likelihood of improving from 3 to 12 months. Those with msPPCS at both assessments were more likely to be women and to have these personal preinjury factors: reduced employment, pain, poor sleep, low resilience, high neuroticism and pessimism, and a psychiatric history. ConclusionsGroup analyses suggest a stable prevalence of msPPCS the first year postinjury. However, there was considerable intraindividual change. Several personal factors were associated with maintaining symptoms throughout the first year.

Age of First Exposure to Football Is Not Associated With Later-in-Life Cognitive or Mental Health Problems.

Background: The purpose of this study was to determine if earlier age of first exposure to football is associated with worse brain health in middle-aged and older adult men who played high school football.Methods: Men from the United States, aged 35 and older, who reported playing high school football, completed a customized, online health survey via the Amazon Mechanical Turk (mTurk) platform. Survey items included physical, psychological, and cognitive symptoms over the past week and over the past year, sports participation history (including age of first exposure to football), medical history, and concussion history. Participants also completed the Patient Health Questionnaire-8 (PHQ-8) and the British Columbia Post-Concussion Symptom Inventory (BC-PSI).Results: There were 186 men (age M = 51.78, SD = 10.93) who participated in high school football, and 87 (46.8%) reported football participation starting before the age of 12 and 99 (53.2%) reported football participation at or after the age of 12. Those who started playing football at an earlier age reported a greater number of lifetime concussions (M = 1.95, SD = 1.79) compared to those who started playing at age 12 or later (M = 1.28, SD = 1.52; U = 3,257.5, p = 0.003). A similar proportion of men who played football before vs. after the age of 12 reported a lifetime history of being prescribed medications for depression, anxiety, chronic pain, headaches, or memory problems. When comparing men who played football before vs. after the age of 12, the groups did not differ significantly in their ratings of depression, anger, anxiety, headaches, migraines, neck or back pain, chronic pain, concentration problems, or memory problems over the past week or the past year. The two groups did not differ significantly in their ratings of current symptoms of depression (PHQ-8; U = 4,187.0, p = 0.74) or post-concussion-like symptoms (BC-PSI; U = 3,944.0, p = 0.53). Furthermore, there were no statistically significant correlations between the age of first exposure to football, as a continuous variable, and PHQ-8 or BC-PSI scores.Conclusion: This study adds to a rapidly growing body of literature suggesting that earlier age of first exposure to football is not associated with later-in-life brain health.

Age of First Exposure to Football Is Not Associated with Midlife Brain Health Problems.

The purpose of this study was to determine if earlier age of first exposure (AFE) to football is associated with worse brain health in middle-aged men who played high school football. We assessed 123 men 35-55 years of age, who played high school football, using (1) a survey of demographic information as well as medical, sport participation, and concussion history; (2) the Patient Health Questionnaire-8 (PHQ-8); and (3) the British Columbia Post-Concussion Symptom Inventory (BC-PSI). Sixty-two (50.4%) men reported football participation starting before the age of 12 (i.e., AFE <12 years) and 61 (49.6%) reported football participation at or after the age of 12 (AFE > 12 years). Compared with those with AFE >12 years, a similar proportion of former high school football players who began playing tackle football before age 12 reported that they had been prescribed medications for mental health problems or that they had recently experienced symptoms of anxiety, depression, memory loss, chronic pain, or headaches. Moreover, there was no significant difference in their lifetime history of treatment by a mental health professional. The groups did not differ significantly on PHQ-8 (U = 1839.0, p = 0.791) or BC-PSI total scores (U = 1828.5, p = 0.751). These findings suggest that earlier AFE to football is not associated with worse brain health in middle-aged men in this sample who played high school football.

Personal Factors Associated With Postconcussion Symptoms 3 Months After Mild Traumatic Brain Injury

ObjectiveTo describe personal factors in patients with mild traumatic brain injury (MTBI) and 2 control groups and to explore how such factors were associated with postconcussion symptoms (PCSs). DesignProspective cohort study. SettingLevel 1 trauma center and outpatient clinic. ParticipantsParticipants (N=541) included patients with MTBI (n=378), trauma controls (n=82), and community controls (n=81). Main Outcome MeasuresData on preinjury health and work status, personality, resilience, attention deficit/hyperactivity, and substance use. Computed tomography (CT) findings and posttraumatic amnesia were recorded. Symptoms were assessed at 3 months with the British Columbia Postconcussion Symptom Inventory and labeled as PCS+ if ≥3 symptoms were reported or the total score was ≥13. Predictive models were fitted with penalized logistic regression using the least absolute shrinkage and selection operator (lasso) in the MTBI group, and model fit was assessed with optimism-corrected area under the curve (AUC) of the receiver operating characteristic curve. ResultsThere were few differences in personal factors between the MTBI group and the 2 control groups without MTBI. Rates of PCS+ were 20.8% for the MTBI group, 8.0% for trauma controls, and 1.3% for community controls. In the MTBI group, there were differences between the PCS+ and PCS− group on most personal factors and injury-related variables in univariable comparisons. In the lasso models, the optimism-corrected AUC for the full model was 0.79, 0.73 for the model only including personal factors, and 0.63 for the model only including injury variables. Working less than full time before injury, having preinjury pain and poor sleep quality, and being female were among the selected predictors, but also resilience and some personality traits contributed in the model. Intracranial abnormalities on CT were also a risk factor for PCS. ConclusionsPersonal factors convey important prognostic information in patients with MTBI. A vulnerable work status and preinjury health problems might indicate a need for follow-up and targeted interventions.

A-128 Age of First Exposure to Football is not Associated with Midlife Brain Health Problems

Abstract Objective This study examined if earlier age of first exposure (AFE) to football is associated with worse brain health in middle-aged men who played high school football. Method Using an online crowdsourcing platform, we recruited 123 men ages 35–55 who played high school football. Participants completed self-report measures that assessed (i) demographic information; (ii) medical history, sport participation, and concussion history; (iii) current depression symptomatology (i.e., Patient Health Questionnaire-8; PHQ-8); and (iv) current concussion-like symptoms (i.e., the British Columbia Post-Concussion Symptom Inventory; BC-PSI). Approximately half (n = 62; 50.4%) reported football participation starting before the age of 12 (AFE12 years). The two groups were compared using chi-squared and Mann–Whitney U-Tests. Results Former high school football players who began playing football before age 12 did not differ in the rates at which they had been prescribed medications for psychological problems or in the rates at which they had recently experienced symptoms of anxiety, depression, memory loss, chronic pain, or headaches compared with former high school football players who began playing football at or after age 12. Additionally, there were no group differences in lifetime history of treatment by a mental health professional (χ2 = 0.20, p = .66) or regarding the PHQ-8 (U = 1,839.0, p = .791) or BC-PSI total scores (U = 1828.5, p = .751). Conclusion These findings suggest that earlier AFE to football is not associated with worse brain health in middle-aged men in this sample who played high school football.

Cognitive Reserve Moderates Cognitive Outcome After Mild Traumatic Brain Injury

ObjectiveTo investigate whether cognitive reserve moderates differences in cognitive functioning between patients with mild traumatic brain injury (MTBI) and controls without MTBI and to examine whether patients with postconcussion syndrome have lower cognitive functioning than patients without postconcussion syndrome at 2 weeks and 3 months after injury. DesignTrondheim MTBI follow-up study is a longitudinal controlled cohort study with cognitive assessments 2 weeks and 3 months after injury. SettingRecruitment at a level 1 trauma center and at a general practitioner-run, outpatient clinic. ParticipantsPatients with MTBI (n=160) according to the World Health Organization criteria, trauma controls (n=71), and community controls (n=79) (N=310). Main Outcome MeasuresA cognitive composite score was used as outcome measure. The Vocabulary subtest was used as a proxy of cognitive reserve. Postconcussion syndrome diagnosis was assessed at 3 months with the British Columbia Postconcussion Symptom Inventory. ResultsLinear mixed models demonstrated that the effect of vocabulary scores on the cognitive composite scores was larger in patients with MTBI than in community controls at 2 weeks and at 3 months after injury (P=.001). Thus, group differences in the cognitive composite score varied as a function of vocabulary scores, with the biggest differences seen among participants with lower vocabulary scores. There were no significant differences in the cognitive composite score between patients with (n=29) and without (n=131) postconcussion syndrome at 2 weeks or 3 months after injury. ConclusionCognitive reserve, but not postconcussion syndrome, was associated with cognitive outcome after MTBI. This supports the cognitive reserve hypothesis in the MTBI context and suggests that persons with low cognitive reserve are more vulnerable to reduced cognitive functioning if they sustain an MTBI.

Fear Avoidance and Clinical Outcomes from Mild Traumatic Brain Injury

Characterizing psychological factors that contribute to persistent symptoms after mild traumatic brain injury (MTBI) can inform early intervention. To determine whether fear avoidance, a known risk factor for chronic disability after musculoskeletal injury, is associated with worse clinical outcomes from MTBI, adults were recruited from four outpatient MTBI clinics and assessed at their first clinic visit (mean = 2.7, standard deviation = 1.5 weeks post-injury) and again four to five months later. Of 273 patients screened, 102 completed the initial assessment, and 87 returned for the outcome assessment. The initial assessment included a battery of questionnaires that measure activity avoidance and associated fears. Endurance, an opposite behavior pattern, was measured with the Behavioral Response to Illness Questionnaire. The multi-dimensional outcome assessment included measures of post-concussion symptoms (British Columbia Postconcussion Symptom Inventory), functional disability (World Health Organization Disability Assessment Schedule-12 2.0), return to work status, and psychiatric complications (MINI Neuropsychiatric Interview). A single component was retained from principal components analysis of the six avoidance subscales. In generalized linear modeling, the avoidance composite score predicted symptom severity (95% confidence interval [CI] for B = 1.22-6.33) and disability (95% CI for B = 2.16-5.48), but not return to work (95% CI for B = -0.68-0.24). The avoidance composite was also associated with an increased risk for depression (odds ratio [OR] = 1.76, 95% CI = 1.02-3.02) and anxiety disorders (OR = 1.89, 95% CI = 1.16-3.19). Endurance behavior predicted the same outcomes, except for depression. In summary, avoidance and endurance behavior were associated with a range of adverse clinical outcomes from MTBI. These may represent early intervention targets.

Work Productivity Loss After Mild Traumatic Brain Injury

ObjectivesTo examine the completeness of return to work (RTW) and the degree of productivity loss in individuals who do achieve a complete RTW after mild traumatic brain injury (MTBI). DesignMultisite prospective cohort. SettingOutpatient concussion clinics. ParticipantsPatients (N=79; mean age, 41.5y; 55.7% women) who sustained an MTBI and were employed at the time of the injury. Participants were enrolled at their first clinic visit and assessed by telephone 6 to 8 months postinjury. InterventionsNot applicable. Main Outcome MeasuresStructured interview of RTW status, British Columbia Postconcussion Symptom Inventory (BC-PSI), Lam Employment Absence and Productivity Scale (LEAPS), Mini International Neuropsychiatric Interview, and brief pain questionnaire. Participants who endorsed symptoms from ≥3 categories with at least moderate severity on the BC-PSI were considered to meet International Classification of Diseases, 10th Revision criteria for postconcussional syndrome. RTW status was classified as complete if participants returned to their preinjury job with the same hours and responsibilities or to a new job that was at least as demanding. ResultsOf the 46 patients (58.2%) who achieved an RTW, 33 (71.7%) had a complete RTW. Participants with complete RTW had high rates of postconcussional syndrome (44.5%) and comorbid depression (18.2%), anxiety disorder (24.2%), and bodily pain (30.3%). They also reported productivity loss on the LEAPS, such as “getting less work done” (60.6%) and “making more mistakes” (42.4%). In a regression model, productivity loss was predicted by the presence of postconcussional syndrome and a comorbid psychiatric condition, but not bodily pain. ConclusionsEven in patients who RTW after MTBI, detailed assessment revealed underemployment and productivity loss associated with residual symptoms and psychiatric complications.

The Nature and Clinical Significance of Preinjury Recall Bias Following Mild Traumatic Brain Injury.

Patients with mild traumatic brain injury (MTBI) often underestimate their preinjury symptoms. This study aimed to clarify the mechanism underlying this recall bias and its contribution to MTBI outcome. Level I trauma center. Patients with uncomplicated MTBI (N = 88) and orthopedic injury (N = 67). Prospective longitudinal. Current and retrospective ratings on the British Columbia Postconcussion Symptom Inventory, completed at 6 weeks and 1 year postinjury. Preinjury symptom reporting was comparable across groups, static across time, and associated with compensation-seeking. High preinjury symptom reporting was related to high postinjury symptom reporting in the orthopedic injury group but less so in the MTBI group, indicating a stronger positive recall bias in highly symptomatic MTBI patients. Low preinjury symptom reporting was not a risk factor for poor MTBI outcome. The recall bias was stronger and more likely clinically significant in MTBI patients with high postinjury symptoms. Multiple mechanisms appear to contribute to recall bias after MTBI, including the reattribution of preexisting symptoms to MTBI as well as processes that are not specific to MTBI (eg, related to compensation-seeking).

Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder

ABSTRACTObjective: This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD–10) criteria for postconcussional syndrome (PCS) in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. Our aims were to: (a) examine relationships among PCS symptoms by identifying potential subscales of the British Columbia Postconcussion Symptom Inventory (BC-PSI); and (b) examine group differences in BC-PSI items and subscales in Veterans with and without blast exposure, mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD). Method: Our sample included Veterans with blast-related mTBI history (n = 47), with blast exposure but no mTBI history (n = 20), and without blast exposure (n = 23). Overall, 37 Veterans had PTSD, and 53 did not. We conducted an exploratory factor analysis (EFA) of the BC-PSI followed by multivariate analysis of variance to examine differences in BC-PSI subscale scores by blast exposure, mTBI history, and PTSD. Results: BC-PSI factors were interpreted as cognitive, vestibular, affective, anger, and somatic. Items and factor scores were highest for Veterans with blast exposure plus mTBI, and lowest for controls. Vestibular, affective, and somatic factors were significantly higher for Veterans with blast exposure plus mTBI than for controls, but not significantly different for those with blast exposure but no mTBI. These results remained significant when PTSD symptom severity was included as a covariate. Cognitive, anger, and somatic subscales were significantly higher for Veterans with PTSD, though there was no interaction effect of PTSD and mTBI or blast history. Conclusions: EFA-derived subscales of the BC-PSI differentiated Veterans based on blast exposure, mTBI history, and PTSD.

Alcohol Consumption Does not Impede Recovery from Mild to Moderate Traumatic Brain Injury.

To examine the effect of pre-injury alcohol use, acute alcohol intoxication, and post-injury alcohol use on outcome from mild to moderate traumatic brain injury (TBI). Prospective inception cohort of patients who presented to the Emergency Department with mild to moderate TBI and had a blood alcohol level (BAL) taken for clinical purposes. Those who completed the 1-year outcome assessment were eligible for this study (N=91). Outcomes of interest were the count of post-concussion symptoms (British Columbia Post-Concussion Symptom Inventory), low neuropsychological test scores (Neuropsychological Assessment Battery), and abnormal regions of interest on diffusion tensor imaging (low fractional anisotropy). The main predictors were pre-injury alcohol consumption (Cognitive Lifetime Drinking History interview), BAL, and post-injury alcohol use. The alcohol use variables were moderately to strongly inter-correlated. None of the alcohol use variables (whether continuous or categorical) were related to 1-year TBI outcomes in generalized linear modeling. Participants in this cohort generally had a good clinical outcome, regardless of their pre-, peri-, and post-injury alcohol use. Alcohol may not significantly alter long-term outcome from mild to moderate TBI. (JINS, 2016, 22, 816-827).

Method of symptom assessment influences cognitive, affective and somatic post-concussion-like symptom base rates

Primary objective: To investigate whether assessment method influences the type of post-concussion-like symptoms.Methods and procedures: Participants were 73 Australian undergraduate students (Mage = 24.14, SD = 8.84; 75.3% female) with no history of mild traumatic brain injury (mTBI). Participants reported symptoms experienced over the previous 2 weeks in response to an open-ended question (free report), mock interview and standardized checklist (British Columbia Post-concussion Symptom Inventory; BC-PSI).Main outcomes and results: In the free report and checklist conditions, cognitive symptoms were reported significantly less frequently than affective (free report: p < 0.001; checklist: p < 0.001) or somatic symptoms (free report: p < 0.001; checklist: p = 0.004). However, in the mock structured interview condition, cognitive and somatic symptoms were reported significantly less frequently than affective symptoms (both p < 0.001). No participants reported at least one symptom from all three domains when assessed by free report, whereas most participants did so when symptoms were assessed by a mock structured interview (75%) or checklist (90%).Conclusions: Previous studies have shown that the method used to assess symptoms affects the number reported. This study shows that the assessment method also affects the type of reported symptoms.

Post-Concussion Symptom Reporting after Multiple Mild Traumatic Brain Injuries

The relationship between previous mild traumatic brain injury/injuries (MTBI) and recovery from a subsequent MTBI may be complex. The present study investigated three factors hypothesized to influence this relation: (1) the number of prior MTBIs, (2) the interval between MTBIs, and (3) the certainty level of previous MTBIs. The study design was retrospective cross-sectional. Participants (N=105) were evaluated at a concussion clinic on average 1 month after sustaining an MTBI, defined by World Health Organization diagnostic criteria. Approximately half the sample had at least one previous MTBI. Subgroups with 0, 1, or 2+ previous MTBIs did not differ in levels of current post-concussion symptom reporting on the British Columbia Post-Concussion Symptom Inventory. Time since the most recent previous MTBI was significantly associated with current post-concussion symptom reporting. This relation was best characterized as logarithmic; i.e., the impact of previous MTBI(s) lessens exponentially as time elapses to a subsequent MTBI. Defining previous MTBIs with a higher certainty level (i.e., probable versus possible) was not consistently associated with greater post-concussion symptom reporting. In conclusion, participants with multiple MTBIs did not report more post-concussion symptoms than those with no history of MTBI. Previous MTBI(s), however, were associated with increased symptom reporting from a subsequent MTBI to the extent they occurred closer in time. Having one or two previous remote MTBIs was not associated with worse outcome from subsequent MTBI in this sample.

An Examination of the Expected Symptoms of Postconcussion Syndrome in a Nonclinical Sample

This study examined the robustness of the postconcussion syndrome (PCS) expectation-as-etiology hypothesis using a variation on the typical study design and different symptom assessment methods. Participants were 51 university students with no history of brain injury or neurological disease. Participants reported expected PCS symptoms after being exposed to an established vignette in which they were asked to imagine that they had had a car accident (expectation condition). One week later, they reported their current symptoms (control condition). Symptoms were elicited in both test sessions using each of 3 methods administered in the following fixed order: an open-ended question (eg, how have you been feeling over the past couple of weeks?), prompted interview questions (eg, have you experienced any troubling physical symptoms over the past few weeks?), and checklist (the British Columbia Postconcussion Symptom Inventory). All 3 methods were administered in a paper-and-pencil format. Findings revealed that (a) when responding to structured interview questions or the checklist, participants expected more PCS symptoms from an imagined mild traumatic brain injury when compared with their baseline, (b) the expectation effect was not present when symptoms were elicited by an open-ended question, and (c) almost all participants (approximately 98% of those reporting expected symptoms) met a caseness criterion when symptoms were assessed using a checklist or structured interview. Contrary to predictions, personal knowledge of someone with mild traumatic brain injury did not alter PCS expectancies. The expectation-as-etiology hypothesis, which is one of several factors that has been associated with PCS, may be partly dependent on method of symptom assessment.

Depression, anxiety, and stress as predictors of postconcussion-like symptoms in a non-clinical sample

This study examined the relationship between postconcussion-like symptoms and depressive symptoms, anxiety and stress respectively. Seventy-one university students with a negative concussion history completed the Depression Anxiety Stress Scales (DASS) and the British Columbia Postconcussion Symptom Inventory (BC-PSI). A multiple regression was conducted using the three DASS subscale scores as predictors of postconcussion-like symptoms. Depressive symptoms, anxiety and stress were significantly positively correlated with postconcussion-like symptoms at the bivariate level. When these three factors were examined together 72.9% of variance in BC-PSI total scores was explained overall. Stress and depressive symptoms emerged as significant multivariate predictors explaining 15% and 3% of unique variance, respectively. Anxiety was not a significant multivariate predictor. These results suggest that stress may be a more important predictor of postconcussion-like symptoms than previously identified. Findings are interpreted in light of Iverson (2012) conceptual model of poor outcomes from mild traumatic brain injury.

The good-old-days bias and post-concussion syndrome symptom reporting in a non-clinical sample

Primary objective: To investigate the good-old-days bias, a psychosocial factor associated with post-concussion syndrome (PCS).Study design: Repeated measures comparison of PCS symptoms reported 6 months prior (retrospectively) and currently. A non-clinical sample was used to determine if this bias is a general recall bias.Methods and procedures: Fifty-seven university students with no history of brain injury or neurological disease completed the British Columbia Post-concussion Symptom Inventory. Symptoms were reported on two occasions, spaced 1 week apart, commencing with current symptoms.Main outcomes and results: Using PCS symptom frequency by severity product scores, there was no significant difference in the 13 PCS symptoms reported across occasions, nor the relevant summary score (p = 0.199). These data do not support the presence of a general recall bias. However, significant differences emerged when analysed using a simple count of the total number of endorsed symptoms (p = 0.002, d = 0.39, small-to-medium effect) or the sample percentage that endorsed each symptom (four symptoms were endorsed by fewer participants retrospectively than currently).Conclusions: There is only weak evidence of a general recall bias in this non-clinical sample. Further consideration of the methods used to study this bias and its role clinically is needed.

Base Rates of Postconcussion Syndrome by Method of Symptom Report

This study compared the base rate of postconcussion syndrome (PCS) symptoms using three different assessment methods in a nonclinical sample. Seventy-three university students with no history of brain injury or neurological disease reported symptoms experienced during the previous 2 weeks in response to an open-ended question, a structured interview (simulated), and the British Columbia Postconcussion Symptom Inventory (BC-PSI). Statistically significant differences (all p < .001, d = 1.80–3.93, large effect sizes) were found between the number of symptoms reported on all assessment methods, such that participants reported the most PCS symptoms on the BC-PSI (M = 9.45, SD = 2.52), followed by the structured interview (M = 5.58, SD = 2.02), and the open-ended question (M = 1.86, SD = 1.00). Further, 100%, 92.1%, and 25.4% of the sample reported three or more ICD-10 Category C PCS symptoms on the BC-PSI, structured interview, and open-ended question, respectively. Findings suggest that method of assessment influences PCS base rates, such that symptom elicitation decreases relative to the reduction in prompting associated with each assessment method. Therefore, different diagnostic conclusions may be drawn depending on method of assessment used. Clinicians need to consider how their chosen assessment method may be influencing the symptoms reported by their patients.

Diffusion Tensor Imaging Findings Are Not Strongly Associated With Postconcussional Disorder 2 Months Following Mild Traumatic Brain Injury

To examine the relation between diffusion tensor imaging (DTI) of the corpus callosum and postconcussion symptom reporting following mild traumatic brain injury (MTBI). Sixty patients with MTBI and 34 patients with orthopedic/soft-tissue injuries (Trauma Controls) prospectively enrolled from consecutive admissions to a level 1 trauma center. Diffusion tensor imaging of the corpus callosum was undertaken using a Phillips 3T scanner at 6 to 8 weeks postinjury. Participants also completed a postconcussion symptom checklist. The MTBI group was divided into 2 subgroups based on the International Classification of Diseases, Tenth Revision symptom criteria for postconcussion disorder (PCD): PCD Present (n = 21), PCD Absent (n = 39). Measures of fractional anisotropy and mean diffusivity for the genu, body, and splenium of the corpus callosum. Participants also completed the British Columbia Post-Concussion Symptom Inventory. The MTBI group reported more postconcussion symptoms than the trauma controls. There were no significant differences between MTBI and trauma control groups on all DTI measures. In the MTBI sample, there were no significant differences on all DTI measures between those who did and did not meet the International Classification of Diseases, Tenth Revision research criteria for postconcussion disorder. These data do not support an association between white matter integrity in the corpus callosum and self-reported postconcussion syndrome 6 to 8 weeks post-MTBI.

A Comparison of the Psychometric Properties of 4 Postconcussion Syndrome Measures in a Nonclinical Sample

To investigate the psychometric properties of 4 established postconcussive symptoms (PCS) measures. Ninety-six nonclinical participants (49 university students and 47 nonstudents; 73% male). Nonclinical participants were recruited because PCS symptoms are common in both clinical and nonclinical groups. Rivermead Postconcussion Symptoms Questionnaire, the Postconcussion Syndrome Symptom Scale, the Postconcussion Syndrome Checklist, and the British Columbia Postconcussion Symptom Inventory were completed in a counterbalanced order. Internal consistency and split-half reliability coefficients were calculated for each PCS measure. Convergent validity was examined using intercorrelations between PCS measures. Divergent validity was examined using correlations between each of the PCS measures and depression. PCS measures had moderate to good reliability and were significantly and positively correlated with each other. Divergent validity correlations were generally weaker than those between PCS measures. This study is the first to examine the psychometric properties of multiple PCS measures in a single sample. Given that clinicians may not know in advance the clinical or nonclinical group status of their clients, particularly in mild trauma cases, our data may help researchers and clinicians compare and select PCS measures.