Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 35

J Rehabil Med 2019; 51: 32–39 ORIGINAL REPORT FACTORS ASSOCIATED WITH PERSISTENT POST-CONCUSSION SYMPTOMS FOLLOWING MILD TRAUMATIC BRAIN INJURY IN ADULTS Jennie PONSFORD, PhD 1,2 , Sylvia NGUYEN, DPsych 1,2 , Marina DOWNING, PhD 1,2 , Marije BOSCH, PhD 3,4,12 , Joanne E. MCKENZIE, PhD 5 , Simon TURNER, MBiostat 5 , Marisa CHAU, BBNS(Hons) 3,4 , Duncan MORTIMER, PhD 6 , Russell L. GRUEN, PhD 7–9 , Jonathan KNOTT, PhD 10,11 and Sally GREEN, PhD 5 From the 1 Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, 2 Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, 3 Department of Surgery, Central Clinical School, Monash University, 4 National Trauma Research Institute, The Alfred & Monash University, 5 School of Public Health and Preventive Medicine, Monash University, 6 Centre for Health Economics, Monash Business School, Monash University, 7 Department of Neurosurgery and 8 Department of Trauma, The Alfred Hospital, Melbourne, Australia, 9 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 10 Melbourne Medical School, The University of Melbourne, 11 Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia and 12 Faculty of Economics and Business, University of Groningen, the Netherlands Objectives: Debate regarding factors associated with persistent symptoms following mild traumatic brain injury continues. Nested within a trial aiming to change practice in emergency department mana- gement of mild traumatic brain injury, this study in- vestigated the nature of persistent symptoms, work/ study outcomes, anxiety and quality of life and fac- tors associated with persistent symptoms following injury, including the impact of receiving information about mild traumatic brain injuries in the emergency department. Methods: A total of 343 individuals with mild trau- matic brain injury completed the Rivermead Post- Concussion Symptom Questionnaire, Hospital Anx- iety Depression Scale – Anxiety Scale, and Quality of Life – Short Form an average 7 months post-injury. Results: Overall, 18.7% of participants reported 3 or more post-concussional symptoms, most com- monly fatigue (17.2%) and forgetfulness (14.6%). Clinically significant anxiety was reported by 12.8%, and was significantly associated with symptom re- porting, as were mental and physical quality of life scores. Significant predictors of post-concussional symptoms at follow-up were pre-injury psychologi- cal issues, experiencing loss of consciousness, and having no recall of receiving information about brain injury in the emergency department. Conclusion: This study confirms that loss of cons- ciousness and pre-injury psychological issues are associated with persistent symptom reporting. Not receiving injury information in the emergency de- partment may also negatively influence symptom reporting. Key words: mild traumatic brain injury; post-concussion symptoms; anxiety; quality of life. Accepted Sep 4, 2018; Epub ahead of print Nov 14, 2018 J Rehabil Med 2019; 51: 32–39 Correspondence address: Jennie Ponsford, School of Psychological Sci- ences, Monash University, Clayton, Victoria, 3800, Australia. E-mail: [email protected] M ild traumatic brain injury (mTBI) continues to present considerable controversy. mTBI com- LAY ABSTRACT Loss of consciousness and pre-injury psychological is- sues are associated with persistent post-concussional symptom reporting. Not receiving information about mild traumatic brain injuries in the emergency depart- ment may also negatively influence symptom reporting. monly results in post-concussional symptoms (PCS) in the hours, days or weeks after injury. Whilst most patients have fully recovered within 1–3 months of injury, 15–25% of cases still experience symptoms 3 months post-injury, causing stress and disability (1, 2). Frequencies of persistent PCS vary with study recruitment criteria, setting and timing (3). Most prospective studies have not followed up individuals with mTBI beyond 3 months post-injury. Of studies measuring PCS on the Rivermead Post- Concussion Symptom Checklist (RPQ) 6 or 12 months post-mTBI, rates of PCS have varied from 21% (4) to 49.8% (5) at 6 months, and from 27.3% (6) to 47.9% (5) at 12 months. Overall, there is limited agreement on when symptoms resolve (7). Regarding predictors of persistent PCS, injury severity measures including GCS and PTA do not generally predict outcome following mTBI (1, 4, 8, 9), although recent studies (10, 11) show that higher GCS is associated with less symptom reporting. Loss of consciousness (LOC) has not reliably predicted outcome following mTBI. Intracranial abnormalities are associated with persistent PCS in some studies (12–15), but not others (10, 16). However, most mTBI patients do not show intracranial abnormalities and/or are not scanned. Of demographic predictors, female sex is associated with greater PCS (2, 5, 8–10, 17–20). Older age has been associated with persistent PCS in only 3 mTBI studies (20–22), whilst Van der Naalt et al. (10) found a non-linear relationship of age with PCS reporting. Of all pre-injury factors, presence of pre-injury mental health issues has been the strongest outcome predictor (2, 8–10, 22–24). Studies have also shown that concurrent anxiety and depression is asso- ciated with PCS reporting (4, 8, 10, 16, 25). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2492 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977