Criteria For Postconcussion Syndrome Research Articles

Co-existence of depression and post-concussion syndrome one month after mild traumatic brain injury

ABSTRACT Background Previous studies suggest an association between Post-concussion syndrome (PCS) and depression, both highly prevalent after mTBI. Objective To assess the prevalence and risk-factors of depression among patients with PCS 1 month after mTBI. Methods We prospectively screened 372 mTBI patients admitted in two academic Emergency Departments between 2017 and 2019. One month after mTBI, we administered the Rivermead Post-concussion symptoms Questionnaire (RPQ) and the Patient Health Questionnaire (PHQ-9) questionnaires over the telephone. PCS and depression were defined by RPQ ≥ 12 and PHQ-9 ≥ 10. Multivariate multinomial regression identified baseline factors associated with PCS and depression. Results Two hundred and eight completed RPQ and PHQ-9. Forty-seven patients (22.5%) met criteria for PCS, among which 22 (46.8%) met criteria for depression (PCS+D+). Patients with PCS but without depression were less likely to present with an associated injury (Coefficient = −1.6, p = 0.047) and to report initial sadness (Coefficient = −2.5, p = 0.03). Initial sadness (Coefficient = −1.3, p = 0.047), associated injury (Coefficient = −1.9, p = 0.008), as well as initial nausea (Coefficient = −1.8, p = 0.002), and male sex (Coefficient = 1.8, p = 0.002), were associated with the absence of depression and PCS in comparison with PCS+D+ patients. Conclusion Among patients with PCS 1 month after mTBI, those with depression are more likely to present with initial sadness and with an associated injury.

Persisting symptoms after concussion: Time for a paradigm shift.

Persisting symptoms after concussion: Time for a paradigm shift.

Prevalence of Post-Concussion-Like Symptoms in the General Injury Population and the Association with Health-Related Quality of Life, Health Care Use, and Return to Work.

Little is known about post-concussion-like symptoms in the general injury population and the association of these symptoms with outcome after injury. This study aimed to assess the prevalence of post-concussion-like symptoms in a general injury population and describe the association between post-concussion syndrome (PCS) and health-related quality of life (HRQL), health care use, and return to work. In this longitudinal study of a cohort of injury patients, data were collected 6 and 12 months after their Emergency Department visit. Questionnaires included socio-demographics, health care utilization, return to work and the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) to measure HRQL. The 12-month questionnaire included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). In total, 282 (22.0%) of the 1282 patients met the criteria for PCS. Apart from the high prevalence of PCS in patients with head injuries (29.4%), a considerable proportion of non-head injury patients also had PCS (20.6%) a year after injury. Patients with PCS had lower HRQL, lower return to work rates, and higher health care utilization, compared to patients without PCS. This underlines the importance of developing strategies to prevent post-concussion-like symptoms among injury patients, raising awareness among patients and physicians on the occurrence of PCS, early detection of PCS in the general injury population, and development of strategies to optimize recovery in this group of injury patients, ultimately leading to lower the individual and economic burden of injury.

Postconcussion symptom reporting is not associated with diffusion tensor imaging findings in the subacute to chronic phase of recovery in military service members following mild traumatic brain injury

ABSTRACTIntroduction: The purpose of this study was to examine the relation between white matter integrity of the brain and postconcussion symptom reporting following mild traumatic brain injury (MTBI).Method: Participants were 109 U.S. military service members (91.7% male) who had sustained a MTBI (n = 88) or orthopedic injury without TBI (trauma controls, TC, n = 21), enrolled from the Walter Reed National Military Medical Center, Bethesda, Maryland. Participants completed a battery of neurobehavioral symptom measures and underwent diffusion tensor imaging (DTI; General Electric 3T) of the whole brain, on average 44.9 months post injury (SD = 42.3). Measures of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were generated for 18 regions of interest (ROIs). Participants in the MTBI group were divided into two subgroups based on International Classification of Diseases–10th Revision (ICD–10) Category C criteria for postconcussion syndrome (PCS): PCS-present (n = 41) and PCS-absent (n = 47).Results: The PCS-present group had significantly worse scores on all 13 neurobehavioral measures than the PCS-absent group (p < .001, d = 0.87–2.50) and TC group (p < .003, d = 0.84–2.06). For all ROIs, there were no significant main effects across the three groups for FA, MD, AD, and RD (all ps >.03). Pairwise comparisons revealed no significant differences for all ROIs when using FA and RD, and only two significant pairwise differences were found between PCS-present and PCS-absent groups when using MD and AD [i.e., anterior thalamic radiation and cingulate gyrus (supracallosal) bundle].Conclusions: Consistent with past research, but not all studies, postconcussion symptom reporting was not associated with white matter integrity in the subacute to chronic phase of recovery following MTBI.

Baseline concussion symptom score differences comparing collision, contact, and noncontact sports and comparison of between sexes

ObjectiveTo determine if baseline concussion symptoms scores in athletes prior to the start of their season vary by sport or sex.BackgroundConcussion is a clinical diagnosis that includes an appropriate clinical scenario, reporting of symptoms through a post concussion symptom score list, and an objective neurologic exam. Symptom reporting is considered when determining if an athlete has recovered from their concussion. Recent studies have shown that athletes at baseline can report symptoms at a rate high enough to meet criteria for post concussion syndrome without any history of concussion. The number of symptoms reported was found to be higher in female athletes than male athletes, but to date there has not been a clear consideration of how these symptoms compare across different sports played.MethodsRetrospective chart review of baseline pre-participation sport exams from 2016. More than 2000 charts were reviewed for age, sex, sport played, number of past concussions. Baseline concussion symptom checklist scores were reviewed for number of symptoms reported and severity of symptoms reported. Comparisons were made between groups comparing age, sex, sport played, and number of previous concussions prior to the start of this season.ResultsFemale athletes in all sports compared reported more baseline symptoms and more severe symptoms compared to their male counterparts. Athletes of the same sex, male or female who participated in collision or contact sports reported less baseline symptoms than athletes who participated in noncontact sports.ConclusionContact and collision sport athletes report at baseline less concussion checklist symptoms than noncontact sport athletes in all age groups compared. This leads to many questions about why certain athlete populations report less symptoms. Symptom reporting could be due to underlying physical traits in different sports, or player psychology differences between sports.

Divergent Classification Methods of Post-Concussion Syndrome after Mild Traumatic Brain Injury: Prevalence Rates, Risk Factors, and Functional Outcome.

Mild traumatic brain injury (mTBI) is a common diagnosis and approximately one third of mTBI patients experience a variety of cognitive, emotional, psychosocial, and behavioral post-concussion symptoms. When a cluster of these symptoms persists for more than 3 months they are often classified as post-concussion syndrome (PCS). The objective of this study was to determine prevalence rates, risk factors, and functional outcome associated with PCS 6 months after mTBI, applying divergent classification methods. Follow-up questionnaires at 6 months after mTBI included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and the Glasgow Outcome Scale Extended (GOSE). The RPQ was analyzed according to different classification methods: the mapped International Classification of Diseases, 10th revision (ICD-10)/Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the RPQ total score, the RPQ3 and the three-factor model using two different cutoff points (mild or worse and moderate or worse). Our results from a sample of 731 mTBI patients showed that prevalence rates of PCS ranged from 11.4% to 38.7% using divergent classification methods. According to all eight methods, 6.3% (n = 46) of mTBI patients experienced PCS. Applying the divergent classification methods resulted in a different set of predictors being statistically significantly associated with PCS, and a different percentage of overlap with functional impairment, measured with the GOSE. In conclusion, depending on the classification method and rating score used, prevalence rates of PCS deviated considerably. For future research, consensus regarding the diagnostic criteria for PCS and the analysis of the RPQ should be reached, to enhance comparability of studies regarding PCS after mTBI.

Frequency of Post-Concussion Syndrome in Korean Patients with Minor Head Injury

Purpose: To determine the incidence of post-concussion syndrome (PCS) in Korean patients after minor traumatic brain injury. Methods: We conducted an observational cohort study of a convenience sample of patients presenting to the emergency department of a major academic Korean hospital. Patients who visited the Emergency Department for head trauma were screened. A researcher questioned the subject regarding his or her symptoms. Subjects were contacted by phone approximately 2 weeks after their Emergency Department visit and questioned about subsequent symptoms and subsequent visits for medical care. Results: Only 8% of subjects reported any post-concussion symptoms. Only 0.4% had three or more symptoms which might have met criteria for PCS. The median peak onset of symptoms was 3 days after injury. Conclusion: The incidence of PCS is Korean patients is much lower than that documented for patients in the United States or other western countries. On the other hand, this study results could give an idea that mild trauma could also cause the PCS. Further study is needed to replicate this finding and investigate possible explanations for this difference. [ J Trauma Inj 2017; 30: 41-46 ]

Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility

ObjectiveDemonstrate implementation, safety and feasibility of multimodal, impairment-based physical therapy (PT) combining vestibular/oculomotor and cervical rehabilitation with sub-symptom threshold exercise for the treatment of patients with post-concussion syndrome (PCS). SettingUniversity hospital outpatient sports medicine facility. ParticipantsTwenty-five patients (12–20 years old) meeting World Health Organization criteria for PCS following sport-related concussion referred for supervised PT consisting of sub-symptom cardiovascular exercise, vestibular/oculomotor and cervical spine rehabilitation. DesignRetrospective cohort. Main measuresPost-Concussion Symptom Scale (PCSS) total score, maximum symptom-free heart rate (SFHR) during graded exercise testing (GXT), GXT duration, balance error scoring system (BESS) score, and number of adverse events. ResultsPatients demonstrated a statistically significant decreasing trend (p < 0.01) for total PCSS scores (pre-PT M = 18.2 (SD = 14.2), post-PT M = 9.1 (SD = 10.8), n = 25). Maximum SFHR achieved on GXT increased 23% (p < 0.01, n = 14), and BESS errors decreased 52% (p < 0.01, n = 13). Two patients reported mild symptom exacerbation with aerobic exercise at home, attenuated by adjustment of the home exercise program. ConclusionsMultimodal, impairment-based PT is safe and associated with diminishing PCS symptoms. This establishes feasibility for future clinical trials to determine viable treatment approaches to reduce symptoms and improve function while avoiding negative repercussions of physical inactivity and premature return to full activity.

Incidence of Postconcussion Symptoms in Psychiatric Diagnostic Groups, Mild Traumatic Brain Injury, and Comorbid Conditions

The constellation of physical, cognitive, and emotional symptoms, collectively known as postconcussion syndrome (PCS), is not uniquely associated with concussion, making the etiology of chronic postconcussion symptoms controversial. The current study compared percentages of individuals meeting symptom-based criteria for PCS in a population-based sample of veterans composed of subgroups with various psychiatric diagnoses, a history of mild traumatic brain injury (MTBI), and healthy controls. Participants were identified from 4462 randomly sampled male U.S. Army veterans who served during the Vietnam era. Only 32% of veterans with a history of MTBI met DSM-IV symptom criteria for PCS as compared to 40% of those diagnosed with post-traumatic stress disorder (PTSD), 50% with generalized anxiety disorder (GAD), 57% with major depressive disorder (MDD), and 91% with somatization disorder. Results were consistent with existing literature showing that the PCS symptoms are not unique to concussion, and also provide important base-rate information for neuropsychologists practicing in both clinical and personal injury forensic settings.

Postconcussion Syndrome: A Physiatrist's Approach

Concussion and its subsequent postconcussive symptoms were first described by p more than a century ago. Since then and through the early 2000s, concus characterized by a myriad of definitions and anecdotally based grading scales an to-play guidelines, miring this injury in controversy. During the past decade, the cation and management of concussive injury has undergone a dramatic “paradigm s Although many of the earlier issues that affect concussion practice and research co persist, including the adoption of consistent definitions and return-to-play guide field has evolved toward a more evidence-based approach. Postconcussion syndrome (PCS), the term most commonly used to refe collection of symptoms that occur after a concussion, remains an area of grea For many years, persons in the fields of neurology and psychiatry professed that co did not result in persistent somatic or behavioral effects [2]. Because treatment predicated on self-report of symptoms, many medical professionals continue t delayed recovery with psychological factors (eg, anxiety or depression) or financi (eg, medicolegal compensation) [3]. Fueling this argument is the fact that the sym PCS are not unique to the injury. Similar symptoms have been reported in uninjure control subjects, personal injury claimants, patients with depression, and patie chronic pain [4,5]. A syndrome is a collection of symptoms that, when taken together, charac underlying condition. Researchers have argued that the collection of symptoms ide PCS are so nonspecific that they do not fulfill requirements of this definition [6]. T recognized and cited definitions of PCS, which are from the Diagnostic and Statistica of Mental Diseases, 4th edition (DSM-IV) [7] and the International Classification of 10th revision (ICD-10) [http://www.ihs-classification.org/en/02_klassifikation/ 05.00.00_necktrauma.html, 8], differ in their language and diagnostic criteria (Ta a prospective study of patients with concussion 3 months after injury, Boake reported that when the DSM-IV criteria were used, the diagnosis rate of postcon disorder was 11%, compared with a diagnosis rate of 64% when the ICD-10 criteri were used. Neither the DSM-IV nor the ICD-10 criteria are specific in differentiating with PCS and/or postconcussional disorder from those with extracranial trauma DSM-IV criteria suggest that symptoms that persist for 3 months are required for the d whereas the ICD-10 criteria do not assert such a time frame. In summary, the inc criteria applied to PCS result in considerable inconsistencies in diagnosis and su treatment for patients with PCS. The debate regarding the diagnostic criteria of PCS revolves around the no nature of its symptoms; however, the underlying factors that may influence the inc PCS also have come under scrutiny. For example, researchers have argued that th incidence of PCS in countries such as the United States and the United Kingdom m medicolegal compensation systems in those countries, because the incidence of been lower in countries without such systems [10]. Mittenberg et al [11] also sug patients may have an “expectation” of symptoms after concussion and there attribute pre-existing symptoms to their concussion. Moreover, researchers have that, within military populations, comorbid post-traumatic stress disorder (PT depression confound the diagnostic criteria for PCS [12]. In the absence of unique biologic markers of concussion and PCS, the aforem issues will continue to invite controversy [13]. However, the emergence of valid and rel

Focal Cortical Dysfunction and Blood???Brain Barrier Disruption in Patients With Postconcussion Syndrome

Postconcussion syndrome (PCS) refers to symptoms and signs commonly occurring after mild head injury. The pathogenesis of PCS is unknown. The authors quantitatively analyzed EEG recordings, localized brain sources for abnormal activity, and correlated it with imaging studies. Data from 17 patients with neurologic symptomatology consistent with ICD-10 criteria for PCS was analyzed. Normalized quantitative EEG (QEEG) revealed significantly higher power in the delta band and lower power in the alpha band compared with matched controls. The generators for the abnormal rhythms were focally localized in neocortical regions. Brain computerized tomography and/or MRI did not reveal focal abnormality at the time of diagnosis. Single photon emission computed tomography (SPECT) after 99mTc-ethylcysteinate dimer administration showed a focal reduction in perfusion in 85% (n = 11) of the patients, and abnormal blood-brain barrier (BBB) after 99mTc-diethylenetriaminepentaacetic acid administration in 73% (n = 8). In 75% of these patients, low-resolution brain electromagnetic tomography analysis showed that the generators for abnormal rhythms were closely related to the anatomic location of the BBB lesion. These data point to focal cortical dysfunction in conjunction with BBB disruption and hypoperfusion as a possible mechanism of pathogenesis in at least some PCS patients, and offer QEEG and SPECT as important tools in evaluating these patients.

Examination of "Postconcussion-Like" Symptoms in a Healthy Sample

The post-concussion syndrome (PCS) is relatively common following mild traumatic brain injury (MTBI). However, the factors that cause and maintain this syndrome continue to be debated. The purpose of this investigation was to examine the prevalence of postconcussion-like symptoms in a sample of healthy individuals. Participants (N = 104) completed the British Columbia Postconcussion Symptom Inventory-Short Form (BC-PSI-Sf), a test designed to measure both the frequency and intensity of ICD-10 criteria for PCS, and the Beck Depression Inventory (2nd ed.). Specific endorsement rates of postconcussion-like symptoms ranged from 35.9% to 75.7% for any experience of the symptoms in the past 2 weeks, and from 2.9% to 15.5% for the experience of more severe symptoms. Symptoms reported on the BC-PSI-Sf also showed a moderately high correlation with self-reported depressive symptoms [r (102) = .76, p < .01]. This study illustrates that the presence of postconcussion-like symptoms: (a) are not unique to mild head injury and are commonly found in healthy individuals, and (b) are highly correlated with depressive symptoms.

Postconcussion syndrome occurs in children.

The consensus of evidence published since 1924 suggests that parents report attention deficits, hyperactivity, or conduct disorder after pediatric head injury rather than postconcussion syndrome. In this study, the symptoms reported by children after mild (n = 38) and moderate-severe (n = 27) head trauma were compared to those reported after orthopedic injury (n = 47) and to adults matched for injury severity and chronicity by using a structured interview based on diagnostic criteria for postconcussion syndrome. Pediatric head trauma caused significantly more subjective symptoms after 6 weeks than orthopedic injury. These symptoms were related to head injury severity and the child's anxiety level. When assessed in a similar manner, children report postconcussion syndrome similar to that seen in adults.