How long is too long? The lack of consensus regarding the post-concussion syndrome diagnosis

Rose, Sean C.; Fischer, Anastasia; Heyer, Geoffrey L.

doi:10.3109/02699052.2015.1004756

Cited by 75 publications

(59 citation statements)

References 26 publications

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“…As mentioned previously, in a study in which more than 500 physicians were surveyed, the majority of the physicians diagnosed PCS in patients with 1 symptom for a minimum of 4 weeks. 42 However, it is important to note that other studies have found an association between concussion symptom inventory scores and PCS. Meehan et al 30 reported that among a host of possible signs and symptoms, only total score on a symptom inventory was associated with symptoms lasting more than 4 weeks.…”

Section: Discussionmentioning

confidence: 96%

“…3 In a survey of more than 500 physicians, the majority of them diagnosed PCS in patients who endorsed at least 1 symptom for a minimum of 4 weeks. 42 Many reports have outlined risk factors for PCS, 8,13,15,17,23,25,28,40,45,50,51 but few studies have been performed in an exclusively sports population. 12,26,30,31,33 Documented risk factors for PCS in athletes include initial symptom score, 26,31 loss of consciousness (LOC), 23 amnesia, 26 and female sex, 28,50 although considerable debate has surrounded each factor.…”

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confidence: 99%

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Predictors of postconcussion syndrome in collegiate student-athletes

Zuckerman

Yengo‐Kahn

Buckley

et al. 2016

FOC

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OBJECTIVE Sport-related concussion (SRC) has emerged as a public health problem, especially among student-athletes. Whereas most concussions resolve by 2 weeks, a minority of patients experience postconcussion syndrome (PCS), in which symptoms persist for months. The objective of this study was to elucidate factors predictive of PCS among a sample of National Collegiate Athletic Association (NCAA) student-athletes in the academic years 2009-2010 to 2014-2015. METHODS The SRC data originated from the NCAA Injury Surveillance Program (ISP) in the 2009-2010 to 2014-2015 academic seasons. The NCAA ISP is a prospective database made up of a convenience sample of schools across all divisions. All SRCs are reported by certified athletic trainers. The PCS group consisted of concussed student-athletes with concussion-related symptoms that lasted ≥ 4 weeks. The non-PCS group consisted of concussed student-athletes with symptom resolution in ≤ 2 weeks. Those with symptoms that resolved in the intermediate area of 2-4 weeks were excluded. Odds ratios (ORs) were estimated using logistic regression. RESULTS During the 2009-2010 to 2014-2015 seasons, 1507 NCAA student-athletes sustained an SRC, 112 (7.4%) of whom developed PCS (i.e., concussion-related symptoms that lasted ≥ 4 weeks). Men's ice hockey contributed the largest proportion of concussions to the PCS group (28.6%), whereas men's football contributed the largest proportion of concussions in the non-PCS group (38.6%). In multivariate analysis, recurrent concussion was associated with increased odds of PCS (OR 2.08, 95% CI 1.28-3.36). Concussion symptoms that were also associated with increased odds of PCS included retrograde amnesia (OR 2.75, 95% CI 1.34-5.64), difficulty concentrating (OR 2.35, 95% CI 1.23-4.50), sensitivity to light (OR 1.97, 95% CI 1.09-3.57), and insomnia (OR 2.19, 95% CI 1.30-3.68). Contact level, sex, and loss of consciousness were not associated with PCS. CONCLUSIONS Postconcussion syndrome represents one of the most impactful sequelae of SRC. In this study of exclusively collegiate student-athletes, the authors found that recurrent concussions and various concussion-related symptoms were associated with PCS. The identification of initial risk factors for the development of PCS may assist sports medicine clinicians in providing timely interventions and treatments to prevent morbidity and shorten recovery time after SRC.

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Section: Discussionmentioning

confidence: 96%

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confidence: 99%

Predictors of postconcussion syndrome in collegiate student-athletes

Zuckerman

Yengo‐Kahn

Buckley

et al. 2016

FOC

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“…104-108 A survey of physician members of the American College of Sports Medicine demonstrated a lack of consensus about how many postconcussion symptoms must be present and how long they must persist to constitute abnormal. 109 The 2012 consensus statement on concussion in sport defines postconcussion symptoms that last beyond 10 days as persistent, 6 whereas the American Medical Society for Sports Medicine requires that symptoms last "weeks to months". 45 Several definitions for the abnormal persistence of postconcussion symptoms have been put forth, with symptom durations ranging from 7 days to 3 months.…”

Section: Clinical Assessment Toolsmentioning

confidence: 99%

The Diagnosis and Management of Concussion in Children and Adolescents

Rose

Weber

Collen

et al. 2015

Pediatric Neurology

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“…46 The agreement between DSM-IV and ICD-10 criteria, however, is poor, 46 the DSM-5 has removed the PCS diagnosis entirely in favor of defining mild or major neurocognitive disorder following TBI, 30 and few clinicians even adhere to DSM or ICD guidelines in practice. 47 Large-scale EHR data offer new opportunities to resolve these diagnostic discrepancies by revealing how TBI patients actually cluster and recover clinically. Data-driven approaches have already uncovered novel autism spectrum disorder subgroups using the EHR, 48 and machine learning algorithms applied to EHR data have accurately predicted suicide attempts up to two years in advance.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic algorithms to study post-concussion syndrome using electronic health records: validating a method to capture an important patient population

Dennis

Yengo‐Kahn

Kirby

et al. 2018

Preprint

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IntroductionPost-concussion syndrome (PCS) is characterized by persistent cognitive, somatic, and emotional symptoms after a mild traumatic brain injury (mTBI). Genetic and other biological variables may contribute to PCS etiology, and the emergence of biobanks linked to electronic health records (EHR) offers new opportunities for research on PCS. We sought to validate the use of EHR data of PCS patients by comparing two diagnostic algorithms.MethodsVanderbilt University Medical Center curates a de-identified database of 2.8 million patient EHR. We developed two EHR-based algorithmic approaches that identified individuals with PCS by: (i) natural language processing (NLP) of narrative text in the EHR combined with structured demographic, diagnostic, and encounter data; or (ii) coded billing and procedure data. The predictive value of each algorithm was assessed, and cases and controls identified by each approach were compared on demographic and medical characteristics.ResultsFirst, the NLP algorithm identified 507 cases and 10,857 controls. The positive predictive value (PPV) in the cases was 82% and the negative predictive value in the controls was 78%. Second, the coded algorithm identified 1,142 patients with two or more PCS billing codes and had a PPV of 76%. Comparisons of PCS controls to both case groups recovered known epidemiology of PCS: cases were more likely than controls to be female and to have pre-morbid diagnoses of anxiety, migraine, and PTSD. In contrast, controls and cases were equally likely to have ADHD and learning disabilities, in accordance with the findings of recent systematic reviews of PCS risk factors.ConclusionsEHR are a valuable research tool for PCS. Ascertainment based on coded data alone had a predictive value comparable to an NLP algorithm, recovered known PCS risk factors, and maximized the number of included patients.

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How long is too long? The lack of consensus regarding the post-concussion syndrome diagnosis

Abstract: There is a lack of consensus regarding the definition of PCS among physician members of the ACSM. A standard definition would improve consistency in concussion research and in clinical practise.

Cited by 75 publications

References 26 publications

Predictors of postconcussion syndrome in collegiate student-athletes

Predictors of postconcussion syndrome in collegiate student-athletes

The Diagnosis and Management of Concussion in Children and Adolescents

Diagnostic algorithms to study post-concussion syndrome using electronic health records: validating a method to capture an important patient population

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