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

Background and Aim: Mild Traumatic Brain Injury (mTBI) mostly develops the symptoms that may persist for over three months known as Post-Concussion Syndrome (PCS). However, the PCS potential risk for mTBI victims is not well-identified. Here, we investigated the putative risk factors of PCS. Methods and Materials/Patients: In a cross-sectional study, we collected (HIS) the demographic, clinical, and radiological data using the hospital information system in 388 mTBI patients who passed at least 3 months since the onset of their injury and referred to Poursina hospital from March 2017 to December 2018. The patients were examined to diagnose PCS by a general physician using the phone interview via the Rivermead Post-concussion Symptoms Questionnaire (RPQ). The subjects were separated into groups with and without PCS. Data were analyzed by parametric t-test, Chi-square test and multiple logistic regression. Results: One-hundred ninety one out of 388 mTBI patients consented to complete the RPQ and around 59% of cases experienced PCS. There was no significant difference in the demographic variables and past medical history between groups. However, the previous psychological disease was particularly associated with PCS (P>0.043). Length of hospitalization, functional outcome during discharge, and post-resuscitation consciousness did not show any significant association with PCS (P<0.05). Interestingly, initial abnormal brain scan, fronto-temporal lesion, and accompanied hematoma (hemorrhages) were identified as risk factors of mTBI-induced PCS. The risk of PCS was found to increase by 7.2 times in mTBI patients demonstrated as an abnormality in their initial brain scans (P<0.001). A directly proportional relationship was found between the occurrence of the syndrome and the fronto-temporal lesion (P<0.017). Accompanied hematoma enhanced the risk of PCS by 2.6 times (P<0.04). Conclusion: This study emphasized the significance of early brain scan data for the prediction of PCS and the necessity of proper follow-up care for the at-risk population. The reported data from this study might be applied as an objective trajectory to measure PCS in those who simulated PCS for the litigation.

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Self-Reported Complaints as Prognostic Markers for Outcome After Mild Traumatic Brain Injury in Elderly: A Machine Learning Approach

Frontiers in Neurology ◽

10.3389/fneur.2021.751539 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mayra Bittencourt ◽

Sebastián A. Balart-Sánchez ◽

Natasha M. Maurits ◽

Joukje van der Naalt

Keyword(s):

Machine Learning ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Elderly Patients ◽

Neck Pain ◽

Functional Outcome ◽

Mild Traumatic Brain Injury ◽

Prognostic Markers ◽

The Elderly ◽

Post Injury

Self-reported complaints are common after mild traumatic brain injury (mTBI). Particularly in the elderly with mTBI, the pre-injury status might play a relevant role in the recovery process. In most mTBI studies, however, pre-injury complaints are neither analyzed nor are the elderly included. Here, we aimed to identify which individual pre- and post-injury complaints are potential prognostic markers for incomplete recovery (IR) in elderly patients who sustained an mTBI. Since patients report many complaints across several domains that are strongly related, we used an interpretable machine learning (ML) approach to robustly deal with correlated predictors and boost classification performance. Pre- and post-injury levels of 20 individual complaints, as self-reported in the acute phase, were analyzed. We used data from two independent studies separately: UPFRONT study was used for training and validation and ReCONNECT study for independent testing. Functional outcome was assessed with the Glasgow Outcome Scale Extended (GOSE). We dichotomized functional outcome into complete recovery (CR; GOSE = 8) and IR (GOSE ≤ 7). In total 148 elderly with mTBI (median age: 67 years, interquartile range [IQR]: 9 years; UPFRONT: N = 115; ReCONNECT: N = 33) were included in this study. IR was observed in 74 (50%) patients. The classification model (IR vs. CR) achieved a good performance (the area under the receiver operating characteristic curve [ROC-AUC] = 0.80; 95% CI: 0.74–0.86) based on a subset of only 8 out of 40 pre- and post-injury complaints. We identified increased neck pain (p = 0.001) from pre- to post-injury as the strongest predictor of IR, followed by increased irritability (p = 0.011) and increased forgetfulness (p = 0.035) from pre- to post-injury. Our findings indicate that a subset of pre- and post-injury physical, emotional, and cognitive complaints has predictive value for determining long-term functional outcomes in elderly patients with mTBI. Particularly, post-injury neck pain, irritability, and forgetfulness scores were associated with IR and should be assessed early. The application of an ML approach holds promise for application in self-reported questionnaires to predict outcomes after mTBI.

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Cognitive function and other risk factors for mild traumatic brain injury in young men: nationwide cohort study

BMJ ◽

10.1136/bmj.f723 ◽

2013 ◽

Vol 346 (mar11 1) ◽

pp. f723-f723 ◽

Cited By ~ 28

Author(s):

A. Nordstrom ◽

B. B. Edin ◽

S. Lindstrom ◽

P. Nordstrom

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Cohort Study ◽

Brain Injury ◽

Cognitive Function ◽

Mild Traumatic Brain Injury ◽

Young Men

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Hyperbaric oxygen therapy for persistent post-concussion syndrome following mild traumatic brain injury

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd012727 ◽

2017 ◽

Author(s):

Yusuke Tsutsumi ◽

Ikuyo Tsutsumi ◽

Yasushi Tsujimoto ◽

Sei Takahashi ◽

Asuka Tsuchiya ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hyperbaric Oxygen ◽

Mild Traumatic Brain Injury ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Post Concussion Syndrome

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Outcomes after Complicated and Uncomplicated Mild Traumatic Brain Injury at Three-and Six-Months Post-Injury: Results from the CENTER-TBI Study

Journal of Clinical Medicine ◽

10.3390/jcm9051525 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1525 ◽

Cited By ~ 1

Author(s):

Daphne C. Voormolen ◽

Marina Zeldovich ◽

Juanita A. Haagsma ◽

Suzanne Polinder ◽

Sarah Friedrich ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Mild Traumatic Brain Injury ◽

Intracranial Injury ◽

Post Injury ◽

Long Term Outcome ◽

Sf 36 ◽

Disease Specific

The objective of this study was to provide a comprehensive examination of the relation of complicated and uncomplicated mild traumatic brain injury (mTBI) with multidimensional outcomes at three- and six-months after TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) research project. Patients after mTBI (Glasgow Coma scale (GCS) score of 13–15) enrolled in the study were differentiated into two groups based on computed tomography (CT) findings: complicated mTBI (presence of any traumatic intracranial injury on first CT) and uncomplicated mTBI (absence of any traumatic intracranial injury on first CT). Multidimensional outcomes were assessed using seven instruments measuring generic and disease-specific health-related quality of life (HRQoL) (SF-36 and QOLIBRI), functional outcome (GOSE), and psycho-social domains including symptoms of post-traumatic stress disorder (PTSD) (PCL-5), depression (PHQ-9), and anxiety (GAD-7). Data were analyzed using a multivariate repeated measures approach (MANOVA-RM), which inspected mTBI groups at three- and six-months post injury. Patients after complicated mTBI had significantly lower GOSE scores, reported lower physical and mental component summary scores based on the SF-36 version 2, and showed significantly lower HRQoL measured by QOLIBRI compared to those after uncomplicated mTBI. There was no difference between mTBI groups when looking at psychological outcomes, however, a slight improvement in PTSD symptoms and depression was observed for the entire sample from three to six months. Patients after complicated mTBI reported lower generic and disease specific HRQoL and worse functional outcome compared to individuals after uncomplicated mTBI at three and six months. Both groups showed a tendency to improve from three to six months after TBI. The complicated mTBI group included more patients with an impaired long-term outcome than the uncomplicated group. Nevertheless, patients, clinicians, researchers, and decisions-makers in health care should take account of the short and long-term impact on outcome for patients after both uncomplicated and complicated mTBI.

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