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