Rivermead Post-Concussion Symptoms Questionnaire Research Articles

Functional Recovery and Life Satisfaction in the First Year After Severe Traumatic Brain Injury: A Prospective Multicenter Study of a Norwegian National Cohort.

(1) To examine the impact of demographic and acute injury-related variables on functional recovery and life satisfaction after severe traumatic brain injury (sTBI) and (2) to test whether postinjury functioning, postconcussive symptoms, emotional state, and functional improvement are related to life satisfaction. Prospective national multicenter study. Level 1 trauma centers in Norway. 163 adults with sTBI. Functional recovery between 3 and 12 months postinjury measured with Glasgow Outcome Scale Extended, Rivermead Postconcussion Symptoms Questionnaire, Hospital Anxiety and Depression Scale, and satisfaction with life situation. 60% of cases experienced functional improvement from 3 to 12 months postinjury. Multivariate logistic regression analysis revealed that discharge to a rehabilitation department from acute care (odds ratio [OR] = 2.14; P < .05) and fewer days with artificial ventilation (OR = 1.04; P < .05) were significantly related to improvement. At 12 months postinjury, 85% were independent in daily activities. Most participants (63%) were satisfied with their life situation. Regression analysis revealed that older age (>65 years), low education, better functional outcome, and the absence of depressive and postconcussion symptoms were significant (P < .05) predictors of life satisfaction. Functional improvement was significantly associated with emotional state but not to life satisfaction. Following sTBI, approximately two-thirds of survivors improve between 3 and 12 months postinjury and are satisfied with their life. Direct discharge from acute care to specialized rehabilitation appears to increase functional recovery.

Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan.

To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery. Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI. Significantly greater impairment was observed in participants with mTBI vs controls: RPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control -11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005). Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely.

Pilot study of traumatic brain injury and alcohol misuse among service members

Objective: Explore relationships among traumatic brain injury (TBI), substance misuse and other mental health disorders in US service members and to identify risk factors for substance misuse.Participants: Service members (n = 93 in final sample) injured while deployed to Operation Enduring Freedom or Operation Iraqi Freedom.Methods and materials: Longitudinal survey at 6 and 12 months post-intake. The following measures were used: problem substance use, Alcohol Expectancies Questionnaire-III, MINI International Neuropsychiatric Interview Substance Abuse Modules, Ohio State University TBI Identification Method, Neurobehavioural Symptom Inventory, Rivermead Post-Concussion Symptoms Questionnaire, Buss-Perry Aggression Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version, Beck Depression Inventory-II, Beck Anxiety Inventory.Results: More severe TBI and post-traumatic stress disorder (PTSD) symptoms at 6 months post-enrolment were associated with decreased odds of substance misuse 12 months after study enrolment. Alcohol expectancies and incurring a TBI at a younger age increased the odds of substance misuse.Conclusions: While the ability to generalize the current findings to a larger population is limited, the results provide direction for future studies on the prevention and treatment of substance misuse following TBI. The unexpected protective effect of more severe TBI may result from prospective attention to the injury and its consequences. Greater preventive benefit may result from identifying more service members with elevated risk. Lifetime history of TBI and alcohol expectancies may be candidate indicators for greater attention.

Traumatic brain injury in juvenile offenders: findings from the comprehensive health assessment tool study and the development of a specialist linkworker service.

Young people in contact with the youth juvenile justice system have well-documented vulnerabilities including high rates of mental health and neurodevelopmental disorders. Studies have suggested that they may also be at increased risk of traumatic brain injury (TBI). (1) To describe the profile of a cohort of juvenile offenders with TBI and associated comorbidity with other neurodevelopmental disorders, mental health needs, and offending behavior. (2) To describe the development of a specialist brain injury service for juvenile offenders with TBI within custody. Ninety-three male participants aged 15 to 18 years were consecutively admitted to a custodial secure facility. They were evaluated using a range of different neurocognitive and mental health measures including the Rivermead Post-Concussion Symptoms Questionnaire and the Comprehensive Health Assessment Tool. Eight-two percent of those interviewed reported experiencing at least 1 TBI, and 44% reported ongoing neuropsychological symptoms. Eighteen percent of those sustaining a TBI reported moderate-severe postconcussion symptoms. There is a high prevalence of TBI in juvenile offenders in custody, with many experiencing multiple episodes. This study highlights the need for further research in this area. An example of a specialist brain injury linkworker service is described as one example of a model of service delivery for this group.

Effects of Hyperbaric Oxygen on Symptoms and Quality of Life Among Service Members With Persistent Postconcussion Symptoms

ImportanceImprovement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date.ObjectivesTo compare the safety of and to estimate the efficacy for symptomatic outcomes from standard PCS care alone, care supplemented with HBO, or a sham procedure.Design, Setting, and ParticipantsMulticenter, double-blind, sham-controlled clinical trial of 72 military service members with ongoing symptoms at least 4 months after mild traumatic brain injury enrolled at military hospitals in Colorado, North Carolina, California, and Georgia between April 26, 2011, and August 24, 2012. Assessments occurred before randomization, at the midpoint, and within 1 month after completing the interventions.InterventionsRoutine PCS care was provided in specialized clinics. In addition, participants were randomized 1:1:1 to 40 HBO sessions administered at 1.5 atmospheres absolute (ATA), 40 sham sessions consisting of room air at 1.2 ATA, or no supplemental chamber procedures.Main Outcomes and MeasuresThe Rivermead Post-Concussion Symptoms Questionnaire (RPQ) served as the primary outcome measure. A change score of at least 2 points on the RPQ-3 subscale (range, 0-12) was defined as clinically significant. Change scores from baseline were calculated for the RPQ-3 and for the total RPQ. Secondary measures included additional patient-reported outcomes and automated neuropsychometric testing.ResultsOn average, participants had sustained 3 lifetime mild traumatic brain injuries; the most recent occurred 23 months before enrollment. No differences were observed between groups for improvement of at least 2 points on the RPQ-3 subscale (25% in the no intervention group, 52% in the HBO group, and 33% in the sham group; P = .24). Compared with the no intervention group (mean change score, 0.5; 95% CI, −4.8 to 5.8; P = .91), both groups undergoing supplemental chamber procedures showed improvement in symptoms on the RPQ (mean change score, 5.4; 95% CI, −0.5 to 11.3; P = .008 in the HBO group and 7.0; 95% CI, 1.0-12.9; P = .02 in the sham group). No difference between the HBO group and the sham group was observed (P = .70). Chamber sessions were well tolerated.Conclusions and RelevanceAmong service members with persistent PCS, HBO showed no benefits over sham compressions. Both intervention groups demonstrated improved outcomes compared with PCS care alone. This finding suggests that the observed improvements were not oxygen mediated but may reflect nonspecific improvements related to placebo effects.Trial Registrationclinicaltrials.gov Identifier: NCT01306968

Sensitivity of the Montreal Cognitive Assessment for Out-Patients With Mild Traumatic Brain Injury

We aimed to assess the sensitivity of the Montreal Cognitive Assessment (MoCA) to screen for cognitive impairments amongst patients with mild traumatic brain injury (mTBI) seen in an outpatient head injury clinic. Our research questions: 1) What proportion of assessed patients demonstrated cognitive impairments as per the MoCA? 2) What patient factors were associated with cognitive impairment as per the MoCA? Cross sectional survey. Level 1 tertiary care urban outpatient head injury clinic. mTBI patients (n=117) assessed between July 2013 and January 2014. Not applicable. MoCA overall and sub-component scores. Patients were assessed on average 37 weeks (range 0-329 weeks) post-injury. Overall, 41.8% (n=49) were cognitively impaired as per the MoCA (score <26/30). The naming and delayed recall sub-components were the most challenging for patients, with 99% (n=116) and 79% (n=92) demonstrating impairments in these components, respectively. Multiple linear regression was used to identify patient specific factors associated with MoCA scores. Controlling for gender, increasing patient age (p=.03), and higher Rivermead Post-Concussion Symptom Questionnaire score (p=.004) were significantly associated with decreasing MoCA scores, collectively explaining 31% of the variance. Duration of loss of consciousness, history of mental illness, history of drug use, and use of alcohol a month prior to injury were not significant in the model. Our findings were similar using Logistic Regression (outcome measured by MoCA score <26/30 versus ≥26/30). The MoCA is sensitive in detecting cognitive impairments amongst patients with persisting post-concussive symptoms assessed in an outpatient setting months following injury.

Symptoms, disabilities, and life satisfaction five years after whiplash injuries

BackgroundChronic whiplash-associated disorders (WADs) are often associated with social functioning problems and decreased ability to perform previous activities. This may lead to decreased life satisfaction, which is insufficiently studied in the context of whiplash injuries. Symptoms included in chronic WAD are similar to symptoms frequently reported by persons who have sustained mild traumatic brain injury (MTBI)/concussion. In cases of MTBI, the severity and number of symptoms have been suggested to have a diagnostic value. The corresponding importance of symptoms in chronic WAD has not been documented. Most studies of whiplash injuries have focused on neck pain because this is the dominant complaint, while other symptoms are less studied. The frequency of long-term symptoms after whiplash injuries seems to vary. It is difficult to compare the long-term outcome since the follow-up after whiplash injury in most studies has been rather short. Therefore, the primary aim of this investigation was to study neck pain and other symptoms, disability, and life satisfaction five years after whiplash injury in a defined population and geographical area. MethodsThe study was carried out at a public hospital in northern Sweden and was a cross-sectional survey of patients five years after the injury event in a cohort of whiplash-injured patients. Five years after the emergency department visit, 186 persons aged 18–64 answered questionnaires on symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire, RHFUQ), and life satisfaction (LiSat-11). The answers were compared to those of a comparison cohort. ResultsThe most common symptoms five years after whiplash injury were fatigue (41%), poor memory (39%), and headache (37%). Inability to sustain previous workload (44%) and fatigue at work (43%) were frequently reported disabilities. Only 39% were satisfied with their somatic health and 60% with their psychological health. Compared with healthy controls, the whiplash injured exhibited more symptoms and had lower life satisfaction. Women reported significantly higher pain intensity than men. Few significant differences between women and men regarding the other parameters were found. ConclusionsThis study shows that five years after a whiplash injury, patients reported symptoms that are typical of mild traumatic brain injury. Further, this study emphasizes the possibility of screening patients with chronic WAD for these symptoms as a complement to the assessment. ImplicationsUntreated symptoms may negatively affect the outcome of pain rehabilitation. This implies that it might be clinically meaningful to quantify symptoms earlier in the rehabilitation process.

Duration and course of post-concussive symptoms.

To examine the incidence, duration, and clinical course of individual post-concussive symptoms in patients presenting to a pediatric emergency department (ED) with a concussion. We conducted secondary analysis of a prospective cohort study of patients 11 to 22 years old presenting to the ED of a children's hospital with an acute concussion. The main outcome measure was duration of symptoms, assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients initially completed a questionnaire describing mechanism of injury, associated symptoms, past medical history, and the RPSQ, then were serially administered the RPSQ for 3 months after the concussion or until all symptoms resolved. Headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, whereas sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up period that had not initially been present. Median duration of symptoms was the longest for irritability (16 days), sleep disturbance (16 days), frustration (14 days), and poor concentration (14 days), whereas nausea, depression, dizziness, and double-vision abated most quickly. One month after injury, nearly a quarter of children still complained of headache, >20% suffered from fatigue, and nearly 20% reported taking longer to think. Among patients presenting to a pediatric ED after a concussion, physical symptoms such as headache predominate immediately after the injury, emotional symptoms tend to develop later in the recovery period, and cognitive symptoms may be present throughout.

Sustained outcomes following mild traumatic brain injury: Results of a five-emergency department longitudinal study

Objective: To report on the occurrence of sustained outcomes including post-concussion symptoms, health services used and indicators of social disruption following a mild traumatic brain injury (MTBI).Research design: A dual cohort comparing MTBI Emergency Department (ED) patients and a comparison group of non-head injured ED patients.Methods and procedures: The outcomes measures employed were the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and indicators of health services used and social disruption all recorded at the ED and at 3 and 6 months post-ED discharge. ‘Sustained’ meant a positive response to these measures at 3 and 6 months.Main outcomes and results: Reasonable follow-up success was achieved at 3 and 6 months and the cohorts were alike on all demographic descriptors. RPQ average score and symptom occurrence were far more frequent among MTBI patients than for the comparison cohort from 3 to 6 months. The use of health services and indicators of social disruption were also more frequent among MTBI post-discharge patients.Conclusions: These findings argue that some with an MTBI suffer real complaints and they are sustained from 3 to at least 6 months. More effort should be given toward specificity of these symptoms from those reported by members of the comparison group.

The emergency department social work intervention for mild traumatic brain injury (SWIFT-Acute): A pilot study

Objective: To determine acceptability and preliminary effectiveness of Emergency Department (ED) Social Work Intervention for Mild Traumatic Brain Injury (SWIFT-Acute) on alcohol use, community functioning, depression, anxiety, post-concussive symptoms, post-traumatic stress disorder and service use.Methods: This study enrolled 64 patients who received head CT after mild traumatic brain injury (mTBI) and were discharged <24 hours from a Level 1 trauma centre ED. The cohort study compared outcomes for SWIFT-Acute (n = 32) and Usual Care (n = 32) 3 months post-injury. SWIFT-Acute includes education about symptoms and decreasing alcohol use, coping strategies, reassurance and education about recovery process and follow-up guidelines and resources.Measures: Alcohol Use Disorders Identification Test (AUDIT), Community Integration Questionnaire (CIQ), Patient Health Questionnaire-4, Rivermead Post-concussion Symptoms Questionnaire, PTSD Checklist-Civilian, acceptability and service use surveys.Results: Paired t-test revealed SWIFT-Acute group maintained pre-injury community functioning; Usual Care significantly declined in functioning on the CIQ. Both groups reported ‘hazardous’ pre-injury drinking on AUDIT. Wilcoxon Signed Rank test showed the SWIFT-Acute group significantly reduced alcohol use; the Usual Care group did not. Both groups significantly increased medical service use. No statistically significant differences were found on other measures. Acceptability ratings were extremely high.Conclusions: SWIFT-Acute was acceptable to patients. There is preliminary evidence of effectiveness for reducing alcohol use and preventing functional decline. Future randomized studies are needed.

How are you really feeling? A prospective evaluation of cognitive function following trauma

Mild traumatic brain injury is associated with persistent cognitive difficulties. However, these symptoms may not be specific to the head injury itself. We sought to evaluate the prevalence of these symptoms in patients following trauma. A prospective analysis of patients who were seen in the outpatient trauma clinic during a 20-month period and completed self-administered Rivermead Post-Concussion Symptoms Questionnaire was conducted. "Significant" difficulty with cognition was defined by two or more symptoms reported as severe or four or more symptoms reported as moderate. Head injury was defined as head Abbreviated Injury Scale (AIS) score greater than 0, including the diagnosis of concussion. Multivariable logistic regression was used to test associations between head injury, injury severity, sex, and age with significant cognitive difficulties, loss of work/school, and unmet physical, occupational, or psychological therapy needs. A total of 587 completed questionnaires were matched to trauma registry admissions (382 early, 111 mid, 86 late). The incidence of significant cognitive difficulties was 37% at less than 1 month, 40% at 1 month to 3 months, and 45% of patients at more than 3 months following injury. Head injury was not associated with increased odds for significant cognitive difficulties (adjusted odds ratio, 1.21; 95% confidence interval, 0.82-1.77; p = 0.3) There was no significant difference in symptoms in patients who carried a head injury diagnosis and those who did not. Cognitive problems occur frequently following injury even in the absence of a head injury diagnosis. Either mild traumatic brain injury is grossly underdiagnosed or these symptoms are not specific to postconcussive states and simply are the cognitive sequelae of traumatic injury. The reporting of moderate-to-severe symptoms suggests a need to better understand the effects of trauma on cognitive function and strongly suggests that services for these patients are badly needed to maximize cognitive function and return to preinjury quality of life. Prognostic/epidemiologic study, level II.

The Effect of Hyperbaric Oxygen on Persistent Postconcussion Symptoms

The high incidence of persistent postconcussion symptoms in service members with combat-related mild traumatic brain injury has prompted research in the use of hyperbaric oxygen (HBO2) for management. The effects of HBO2 on persistent postconcussion symptoms in 60 military service members with at least 1 combat-related mild traumatic brain injury were examined in a single-center, double-blind, randomized, sham-controlled, prospective trial at the Naval Medicine Operational Training Center at Naval Air Station Pensacola. Over a 10-week period, subjects received a series of 40, once-daily, hyperbaric chamber compressions at 2.0 atmospheres absolute (ATA). During each session, subjects breathed 1 of 3 preassigned oxygen fractions (10.5%, 75%, or 100%) for 60 minutes, resulting in an oxygen exposure equivalent to breathing surface air, 100% oxygen at 1.5 ATA, or 100% oxygen at 2.0 ATA, respectively. Individual, subscale and total item responses on the Rivermead Postconcussion Symptom Questionnaire and individual and total Posttraumatic Disorder Checklist-Military Version were measured just prior to intervention and immediately postintervention. Between-group testing of pre- and postintervention means revealed no significant differences on individual or total scores on the Posttraumatic Disorder Checklist-Military Version or Rivermead Postconcussion Symptom Questionnaire, demonstrating a successful randomization and no significant main effect for HBO2 at 1.5 or 2.0 ATA equivalent compared with the sham compression. Within-group testing of pre- and postintervention means revealed significant differences on several individual items for each group and difference in the Posttraumatic Disorder Checklist-Military Version total score for the 2.0 ATA HBO2 group. The primary analyses of between group differences found no evidence of efficacy for HBO2. The scattered within group differences are threatened by Type 2 errors and could be explained by nonspecific effects. This study demonstrated that HBO2 at either 1.5 or 2.0 ATA equivalent had no effect on postconcussion symptoms after mild traumatic brain injury when compared with sham compression.

Specificity of Postconcussion Symptoms at 3 Months After Mild Traumatic Brain Injury

To assess the specificity of symptoms included in various symptom lists used to identify postconcussion syndrome (PCS), by using follow-up data comparing patients with mild traumatic brain injury (MTBI) and control patients during the month prior to injury and 3 months later. The adult emergency department of a teaching hospital in Bordeaux, France. A cohort of patients with MTBI (n = 536) and a comparison group with nonhead injuries (n = 946). Postconcussion symptoms listed in the Rivermead Postconcussion Symptoms Questionnaire (RPQ), the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and the 10th International Classification of Diseases (ICD-10). Analyses were performed comparing symptom occurrence in patients with MTBI and controls, before and 3 months after injury. Eight symptoms were identified as being specific to MTBI: headache, dizziness, intolerance of stress, forgetfulness, poor concentration, taking longer to think, blurred vision, and personality change. The relevance of symptoms proposed to constitute PCS should be reviewed. A more specific definition of PCS would make diagnosis easier and facilitate prevention as well as treatment of patients with MTBI.

Quality of life and perception of illness in patients with traumatic brain injury

ObjectiveTo examine QoL and perception of illness in adult patients with a mild to moderate traumatic brain injury (TBI). Methods and procedureThirty patients gave consent for participation in the study. Questionnaires included Rivermead Post Concussion Symptoms Questionnaire (RPQ), Depression Anxiety Stress Scales (DASS), WHO Quality of Life – BREF Version and Brief Illness Perception Questionnaire (IPQ). ResultsCognitive and emotional complaints were reported by most of the patients. Higher percentages of patients fall in the medium range on all the four domains QoL. However on social and physical domain of QoL, the percentage is to some extent higher on the low range. On IPQ higher percentages fall within low and medium range. However on the coherence and emotional subscales of the IPQ, a higher percentage of patients fall in the higher range. Physical, psychological, environmental domains of QoL were found significantly correlated with overall subscale of IPQ at 0.01 and 0.05 level of significance. And a significant difference was also noted between mild and moderate TBI on IPQ but not on QoL. ConclusionsThe research findings highlight the need to emphasis not on physical but on psychosocial dimensions of individual as well, which may lead to better recovery and outcome.

Does Isolated Traumatic Subarachnoid Hemorrhage Affect Outcome in Patients With Mild Traumatic Brain Injury?

The importance of isolated traumatic subarachnoid hemorrhage (SAH) in relation to functional outcome in patients with mild traumatic brain injury (TBI) has not been frequently studied. The aim of this study was to compare the impact of isolated SAH with normal computed tomographic (CT) scan on outcome of patients with mild TBI. This is a retrospective study of clinical records and CT scans of all patients with mild TBI (Glasgow Coma Scale score ≥13) evaluated from January 1, 2010, to March 15, 2010, at our institution. The patients were divided into 2 groups: isolated SAH and normal CT scan. The telephonic Glasgow Outcome Scale-Extended, Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), and Rivermead Head Injury Follow-up Questionnaire (RHFUQ) scores were used to assess outcome after 1 year of injury. Independent sample t test in SPSS was used to assess difference in outcome. A total of 1149 patients with mild TBI were evaluated during study period. Among them, 34 (2.9%) patients had isolated SAH. Twenty-eight patients were male and 6 were female, with a mean age of 36.5 years. Subarachnoid hemorrhage was cortical in 19 (55.9%) patients, interhemispheric in 3 (8.8%) patients, Sylvian fissure in 2 (5.9%) patients, and basal cisternal in 1 (2.9%) patient. Nine (26.5%) patients had SAH at multiple locations. The mean RPCSQ and RHFUQ scores for patients with isolated SAH were 1.38 ± 2.40 and 1.11 ±3.305, respectively. The mean RPCSQ and RHFUQ scores for patients with normal CT scans were 0.40 ± 1.549 and 0.533 ± 1.59, respectively. There was no significant difference in the outcome scores between the SAH and the normal CT scan groups (RHFUQ, P = .45; RPCSQ, P = .248). In our study sample of patients with mild TBI, there is no difference in outcome of patients with isolated SAH compared with those with normal CT scans 1 year after injury.

Neurogenic and Psychogenic Acute Postconcussion Symptoms Can Be Identified After Mild Traumatic Brain Injury

As provenance of postconcussion symptoms after mild traumatic brain injury (mTBI) is controversial, with similar rates found in other populations, we aimed to identify postconcussion symptoms specific to mTBI compared with controls. We also compared differences between complicated and uncomplicated mTBIs. Hospital emergency department. Adult individuals (34 individuals with complicated mTBI, 76 individuals with uncomplicated mTBI, and 47 orthopedic controls) who sought care in the emergency department and were consecutively recruited by post at 2 weeks postinjury. Rivermead Postconcussion Symptom Questionnaire. Preinjury factors were used as covariates. Compared with orthopedic controls, complicated mTBI group reported greater severity of headaches, dizziness, and nausea, as well as concentration difficulties, suggesting that these are neurogenic. Severity of other symptoms measured on the Rivermead Postconcussion Symptom Questionnaire was not significantly different between these groups, suggesting that these are psychogenic. Differences were evident between the 2 mTBI samples on the items of dizziness, nausea, fatigue, sleep disturbance, and concentration difficulties. Neurogenic and psychogenic postconcussion symptoms were identified at the acute-phase postinjury. Findings suggest that treating persons with mTBI as a homogenous sample is not prudent. This should inform prognostic models and follow-up support offered after leaving the emergency department.

Time Interval Between Concussions and Symptom Duration

To test the hypothesis that children with a previous history of concussion have a longer duration of symptoms after a repeat concussion than those without such a history. Prospective cohort study of consecutive patients 11 to 22 years old presenting to the emergency department of a children's hospital with an acute concussion. The main outcome measure was time to symptom resolution, assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients and providers completed a questionnaire describing mechanism of injury, associated symptoms, past medical history, examination findings, diagnostic studies, and the RPSQ. Patients were then serially administered the RPSQ for 3 months after the concussion or until all symptoms resolved. A total of 280 patients were enrolled over 12 months. Patients with a history of previous concussion had a longer duration of symptoms than those without previous concussion (24 vs 12 days, P = .02). Median symptom duration was even longer for patients with multiple previous concussions (28 days, P = .03) and for those who had sustained a concussion within the previous year (35 days, P = .007) compared with patients without those risk factors. In a multivariate model, previous concussion, absence of loss of consciousness, age ≥13, and initial RPSQ score >18 were significant predictors of prolonged recovery. Children with a history of a previous concussion, particularly recent or multiple concussions, are at increased risk for prolonged symptoms after concussion. These findings have direct implications on the management of patients with concussion who are at high risk for repeat injuries.

Bicycle accident.related head injuries in India

Objectives:To describe the epidemiology of head injuries sustained due to bicycle accidents in India.Materials and Methods:Data were retrospectively collected over a period of six months (15 May 2011 to 15 November 2011). Demography of patients, Glasgow coma scale (GCS), clinical and imaging findings, and mortality and outcome using Glasgow outcome scale (GOS), Rivermead post-concussion symptom questionnaire (RPCSQ) and Rivermead head injury follow-up questionnaire (RHFUQ), were analyzed. Outcome was assessed by telephonic interview.Results:There were 108 patients (100 males) with mean age of 27.7 years. Seventy-four (68.5%) were from rural areas. Accidents due to vehicular collision accounted for 60 (55.6%) cases. None wore a helmet. The admission GCS was 14-15 in 68.5% cases, 13-3 in 31.5%. The risk of moderate to severe injuries was increased among working laborers (OR = 5), and patients with loss of consciousness (OR = 4). Sixty-three (49%) patients had abnormal computed tomography (CT) findings; most common finding was skull fracture 25 (23.1%). Four patients needed surgery. The GOS assessment at three to six months revealed favorable outcome in 66 patients (61.1%) and death in 8 (7.4%). The common post-concussion symptoms were headache, fatigue, and poor concentration.Conclusion:The majority of hospitalized cyclists were from a rural background and of the lower income group. After three months the majority of patients had good recovery with few persistent concussion symptoms.

Mobile Phone Text Messaging to Assess Symptoms After Mild Traumatic Brain Injury and Provide Self-Care Support

To examine whether patients with mild traumatic brain injury (mTBI) receiving text messaging-based education and behavioral support had fewer and less severe postconcussive symptoms than those not receiving text-message support. Our secondary objective was to determine the feasibility of using text messaging to assess daily symptoms and provide support to patients with mTBI. Randomized controlled trial with 14-day follow-up. Convenience sample of 43 adult emergency department patients with mTBI. Fourteen days of timed SMS (short-message service) symptom assessments (9 AM: headaches; 1 PM: difficulty concentrating; 5 PM: irritability or anxiety) with self-care support messages. SMS symptom reports, Rivermead Postconcussion Symptoms Questionnaire. Compared with the control group, intervention participants trended to lower odds of reporting headaches (odds ratio [OR] = 0.38; 95% confidence interval [CI]: 0.07-1.99), concentration difficulty (OR = 0.32; 95% CI: 0.04-2.24), and irritability or anxiety (OR = 0.33; 95% CI: 0.05-2.35). There were also trends of lower mean scores for headaches (0.99 vs 1.19; P = .5), difficulty concentrating (0.88 vs 1.23; P = .2), and irritability/anxiety (1.00 vs 1.62; P = .06). There were high response rate to SMS symptom assessments and high satisfaction with the intervention. Those receiving the text messaging-based education and support had fewer and less severe postconcussive symptoms than the controls but none of the differences reached statistical significance. Further evaluation of more robust mobile interventions and larger sample of participants are still needed.

Cognitive-Behavioral Prevention of Postconcussion Syndrome in At-Risk Patients

To examine the tolerability and estimate the treatment effect of cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain injury to patients at risk for chronic postconcussion syndrome (PCS). Tertiary rehabilitation center. Twenty-eight patients with uncomplicated mild traumatic brain injury, determined to be at risk for chronic PCS based on a published algorithm that incorporates subacute postconcussion symptoms and maladaptive illness beliefs (recovery expectations and perceived consequences). They were enrolled within 6 weeks postinjury. Open-label, parallel-group, randomized controlled trial, with masked outcome assessment 3 months after enrolment. Interventions were (1) treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist, or (2) treatment as usual plus CBT delivered by a psychologist. Rivermead Postconcussion Symptoms Questionnaire. Four participants (2:2) withdrew. Treatment credibility and satisfaction ratings were high in the CBT group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d = 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up (54% vs 91%, P < .05). Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.