Personal Factors Associated With Postconcussion Symptoms 3 Months After Mild Traumatic Brain Injury

Abstract

To describe personal factors in patients with mild traumatic brain injury (MTBI) and 2 control groups and to explore how such factors were associated with postconcussion symptoms (PCSs). Design: Prospective cohort study. Setting: Level 1 trauma center and outpatient clinic. Participants: Participants (NZ541) included patients with MTBI (nZ378), trauma controls (nZ82), and community controls (nZ81). Main Outcome Measures: Data on preinjury health and work status, personality, resilience, attention deficit/hyperactivity, and substance use. Computed tomography (CT) findings and posttraumatic amnesia were recorded. Symptoms were assessed at 3 months with the British Columbia Postconcussion Symptom Inventory and labeled as PCSþ if !3 symptoms were reported or the total score was !13. Predictive models were fitted with penalized logistic regression using the least absolute shrinkage and selection operator (lasso) in the MTBI group, and model fit was assessed with optimism-corrected area under the curve (AUC) of the receiver operating characteristic curve. Results: There were few differences in personal factors between the MTBI group and the 2 control groups without MTBI. Rates of PCSþ were 20.8% for the MTBI group, 8.0% for trauma controls, and 1.3% for community controls. In the MTBI group, there were differences between the PCSþ and PCSÀ group on most personal factors and injury-related variables in univariable comparisons. In the lasso models, the optimismcorrected AUC for the full model was 0.79, 0.73 for the model only including personal factors, and 0.63 for the model only including injury variables. Working less than full time before injury, having preinjury pain and poor sleep quality, and being female were among the selected predictors, but also resilience and some personality traits contributed in the model. Intracranial abnormalities on CT were also a risk factor for PCS. Conclusions: Personal factors convey important prognostic information in patients with MTBI. A vulnerable work status and preinjury health problems might indicate a need for follow-up and targeted interventions.

Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury

“…Our main aim was to investigate specific between-group effects while maintaining control of key demographic variables that are typically associated with reporting physical, cognitive, and emotional symptoms associated with PPCS. Given that there were no between-group differences in age, sex, or education and the groups have been found to be similar regarding a range of psychosocial variables, 44 there is no obvious reason to believe that recruitment bias is a driver of the results supporting our main conclusion.…”

Acute Diffusion Tensor and Kurtosis Imaging and Outcome following Mild Traumatic Brain Injury

“…The control group was found to be comparable to the mTBI group on a broad range of personal factors. 40 The study was approved by the regional committee for research ethics (REK 2013/754), and participants and parents of participants younger than 18 years gave informed consent.…”

“…PPCS was defined as having ≥ 3 core symptoms rated at least moderate (score ≥ 3), or a total score of 13-52 (i.e., 52 is the highest possible score). 40…”

The impact of pre‐morbid headaches on headache features and long‐term health outcomes following traumatic brain injury: Insights from the American Registry for Migraine Research

“…[11][12][13][14] Studies of mild TBI (mTBI) have suggested that outcomes are impacted by pre-TBI sociodemographics, use of alcohol and tobacco, prior TBIs, and presence of psychiatric and neurological diseases. 11,[15][16][17][18][19][20] In particular, individuals with pre-existing migraine have reported greater and different post-concussive symptoms and had worse verbal and visual memory within the first 72 h after concussion measured by Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) compared to individuals who did not have pre-existing migraine. 14 In another study the presence of pre-TBI headache/migraine predicted greater disability, sleep problems, and emotional symptoms at 3 months post mTBI, and physical post-concussive symptoms at 6 months post-TBI.…”