After head injuries, particularly mild or moderate ones, a range of post-concussion symptoms (PCS) are often reported by patients. Such symptoms may significantly affect patients' psychosocial functioning. To date, no measure of the severity of PCS has been developed. This study presents the Rivermead Post Concussion Symptoms Questionnaire (RPQ) as such a measure, derived from published material, and investigates its reliability. The RPQ's reliability was investigated under two experimental conditions. Study 1 examined its test-retest reliability when used as a self-report questionnaire at 7-10 days after injury. Forty-one head-injured patients completed an RPQ at 7-10 days following their head injury and again approximately 24 h later. Study 2 examined the questionnaire's inter-rater reliability when used as a measure administered by two separate investigators. Forty-six head-injured patients had an RPQ administered by an investigator at 6 months after injury. A second investigator readministered the questionnaire approximately 7 days later. Spearman rank correlation coefficients were calculated for ratings on the total symptom scores, and for individual items. High reliability was found for the total PCS scores under both experimental conditions (Rs = + 0.91 in study 1 and Rs = + 0.87 in study 2). Good reliability was also found for individual PCS items generally, although with some variation between different symptoms. The results are discussed in relation to the major difficulties involved when looking for appropriate experimental criteria against which measures of PCS can be validated.

Objective-To confirm that patients admitted to hospital with a head injury benefit from a routinely oVered early intervention service. Patients and methods-A mixed rural and urban Health District of 560 000 people with two accident and emergency departments provided the setting. Existing routine services for most patients with head injury are minimal. All patients aged 16-65 years admitted to hospital after a head injury of any severity, with or without other injuries entered the trial. Prospective randomisation, with a block randomisation procedure was used to allocate all eligible patients to either: a group oVered an additional service by a specialist team; or a group receiving existing standard services. Patients were assessed at follow up six months after injury. The primary outcome measure was the Rivermead head injury follow up questionnaire, a validated and reliable measure of social disability. The Rivermead post-concussion symptoms questionnaire was used to estimate severity of post-concussion symptoms. Each patient in the trial group was contacted 7-10 days after injury, and oVered assessment and interventions as needed. These initially focused on the provision of information, support, and advice. Forty six per cent of patients in the trial group also received further outpatient intervention or additional support by telephone. Results-314 patients were registered: 184 were randomised into the trial group, 130 into the control group. For prognostic data, the groups were comparable at randomisation, and remained comparable when assessed at six months. 132 trial and 86 control patients were followed up at six months after injury. Patients' posttraumatic amnesia ranged from mild (n=79, 40%), and moderate (n=62, 32%), to severe (n=38, 19%) and very severe (n=17, 9%). The trial group patients had significantly less social disability (p=0.01) and significantly less severe post-concussion symptoms (p=0.02) at follow up at six months after injury than the control group patients. Conclusions-The early interventions offered by a specialist service significantly reduced social morbidity and severity of post-concussion symptoms in trial group patients at six months after head injury. Recommendations about how specialist services should be targeted are made both in the light of these results and those from a previous randomised controlled trial.

Background-After mild and moderate head injuries a range of postconcussion symptoms (PCS) are often reported by patients. Both organic and psychogenic factors can contribute to these. Full recovery from PCS usually occurs within three months of the injury. A significant minority, however, continue to experience symptoms beyond this time. To date, no means of identifying these patients early after injury has been reported. This study investigates whether a combination of neuropsychological, emotional, and traditional measures of severity of head injury taken early after the injury can help predict severity of PCS three months after injury. Methods-50 patients with mild or moderate head injury had a range of measures administered at 7-10 days after injury. These included three tests of divided attention, a PCS rating scale-the Rivermead postconcussion symptoms questionnaire (RPQ), the hospital anxiety and depression scale (HADS), the impact of event scale (IES), and post-traumatic amnesia. An RPQ was then completed by all patients three months after injury. Results-Stepwise multiple regression analysis was performed with the RPQ score at three months as the dependent measure. A combination of eight of the scores from the early measures gave a multiple correlation coefficient of R = 086 accounting for 74%/o of the variance in RPQ scores. The most predictive individual measures were the HADS and IES. Regression analysis with RPQ score at 7-10 days as dependent measure showed that 10 of the scores gave a coefficient of R = 0-84 accounting for 71% of the variance.

Objective-To evaluate the Medical

Very high levels of PCS, high post-injury unemployment and measurable cognitive deficits can be permanent features of MHI. Quality-of-life is directly related to symptom severity. Age, pre-/post-morbid concomitant factors, neuropsychological deficits and emotional status are key variables in understanding the phenomenon of permanent PCS. Important vulnerability factors in the development of such may therefore be older age and any additional compromise to an individual's emotional or cognitive capacities.