Postconcussive symptoms after uncomplicated mild head injury

Alves, Wayne M.; Macciocchi, Stephen N.; Barth, Jeffrey T.

doi:10.1097/00001199-199309000-00007

Cited by 273 publications

(132 citation statements)

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“…Other predictors include learning disabilities, 44 migraine headaches, 19 females, 1,[4][5][6]10,12,13,26,32,39 older age, 18,21,39 and children and adolescents. 15,27 Lastly, those with previous concussions are believed to have an increased risk of PCS, 3,7,13,19,27,32,44 although the exact number required to increase the risk is unknown.…”

Section: 39mentioning

confidence: 99%

Postconcussion syndrome: demographics and predictors in 221 patients

Tator

Davis

Dufort

et al. 2016

JNS

109

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abbreviations ADD = attention-deficit disorder; ADHD = attention-deficit hyperactivity disorder; CTE = chronic traumatic encephalopathy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; GCS = Glasgow Coma Scale; ICD-10 = International Classification of Diseases, 10th Revision; LOC = loss of consciousness; PCS = postconcussion syndrome; PTSD = posttraumatic stress disorder; TBI = traumatic brain injury. obJective The objective of this study was to determine the demographics and predictors of postconcussion syndrome (PCS) in a large series of patients using a novel definition of PCS. methods The authors conducted a retrospective cohort study of 284 consecutive concussed patients, 221 of whom had PCS on the basis of at least 3 symptoms persisting at least 1 month. This definition of PCS was uniformly employed and is unique in accepting an expanded list of symptoms, in shortening the postconcussion interval to 1 month from 3 months, and in excluding those with focal injuries such as hemorrhages and contusions. resUlts The 221 cases showed considerable heterogeneity in clinical features of PCS. They averaged 3.3 concussions, with a range of 0 to 12 or more concussions, and 62.4% occurred during sports and recreation. The median duration of PCS was 7 months at the time of examination, with 11.8% lasting more than 2 years, and 23.1% with PCS had only 1 concussion. The average patient age was 27 years (range 10-74 years). The average number of persistent symptoms was 8.1; 26.2% had a previous psychiatric condition, attention-deficit disorder/attention-deficit hyperactivity disorder, a learning disability, or previous migraine headaches. The prevalence of arachnoid cysts and Chiari malformation in PCS exceeded the general population. Additionally, involvement in litigation, presence of extracranial injuries, amnesia and/or loss of consciousness, and female sex were predictive of reporting a high number of symptoms. A prior history of psychiatric conditions or migraines, cause of injury, number of previous concussions, and age did not significantly predict symptom number. Only the number of symptoms reported predicted the duration of PCS. To predict the number of symptoms for those who fulfilled PCS criteria according to the International Classification of Diseases, and the Diagnostic and Statistical Manual of Mental Disorders,, the number of previous concussions was significant. conclUsions PCS is commonly associated with multiple concussions, but 23.1% in the present series occurred after only 1 concussion. Most patients with PCS had multiple symptoms persisting for months or years. The median duration of PCS was 7 months, with a range up to 26 years. In only 11.3%, the PCS had ended at the time of consultation. Not all predictors commonly cited in the literature align with the findings in this study. This is likely due to differences in the definitions of PCS used in research. These results suggest that the use of ICD-10 and DSM-IV to diagnose PCS may be biased toward those who are vulnerabl...

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Section: 39mentioning

confidence: 99%

Postconcussion syndrome: demographics and predictors in 221 patients

Tator

Davis

Dufort

et al. 2016

JNS

109

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“…Evidence from other studies suggests that a clinically significant number of patients with mild TBI (up to 40%) remain impaired from both a neuropsychological and an occupational standpoint up to at least one year post injury. 15,16 In addition to examining the long-term sequelae of mild TBI, future research should determine the effectiveness of preventive interventions for TBI, examine the influences of managed care and health care financing on the treatment of TBI, and evaluate the impact of new therapeutic modalities for those who have sustained TBI.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

Traumatic Brain Injuries Evaluated in U.S. Emergency Departments, 1992‐1994

Jager

Weiss

Coben

et al. 2000

Academic Emergency Medicine

289

169

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Abstract. Objective: To describe the incidence and patient characteristics of traumatic brain injuries (TBIs) treated in U.S. emergency departments (EDs). Methods: A secondary analysis was performed on data from the National Hospital Ambulatory Medical Care Survey administered from 1992 to 1994. An ED visit was determined to represent a case of TBI if the case record contained ICD-9-CM codes of 800.0-801.9, 803.0-804.9, or 850.0-854.1. Results: The average annual estimate of new TBI treated in U.S. EDs was 1,144,807, equaling 444 per 100,000 persons (95% CI = 390 to 498), which represents approximately 3,136 new cases of TBI per day and accounts for 1.3% of all ED visits. Males were 1.6 times as likely as females to suffer TBI until the age of 65 years, when the female rate exceeded the male. The rate for blacks was 35% higher than that for whites.

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“…3,36,37 Some patients have reported symptoms to resolve within 7-10 days 23 , meanwhile other patients suffer from persistent post-concussive symptoms (PPCS) often having symptoms lasting from months to years. 1,19,23 Currently, it is not well understood why some patients who sustain head impacts have concussion with transient symptoms while other patients suffer from PPCS.…”

Section: Introductionmentioning

confidence: 99%

A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma

Oeur

Karton

Post

et al. 2015

JNS

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Objective:Concussions typically resolve within a few days however in a few cases the symptoms last for a month or longer and are termed persistent post-concussive symptoms (PPCS) with more serious brain trauma resulting in bleeds, such as subdural hematoma (SDH). Dynamic response and brain tissue deformation characteristics may provide a means of distinguishing between these three types of injuries. Methods:Reconstruction cases were recruited from sports medicine clinics and hospitals along with medical reports, video footage, and medical imaging. All subjects received a direct blow to the head resulting in head trauma symptoms, those that resolved in 9 days were termed concussions, those with symptoms longer than 18 months were PPCS and those presenting with subdural hematoma (SDH). An anthropometric dummy headform was dropped onto various impact surfaces using a monorail drop rig. Headform dynamic response data was collected and used as input into the University College Dublin Brain Trauma Model to obtain maximum principal strain and von Mises stress. Results:Both linear and rotational acceleration of the head increased in magnitude with an increase in injury severity (from concussion, to PPCS, and SDH). The PPCS group had peak resultant rotational accelerations similar to SDH and significantly higher than concussions. There were no significant differences for peak resultant linear accelerations between the two concussion groups however they were both significantly lower than the SDH group. Brain tissue deformation measures however, did not follow the same trend as dynamic response and resulted with SDH having the lowest values of stress and strain. PPCS had significantly higher values of strain than the SDH group, where both the concussion and PPCS groups had significantly higher stress values than the SDH group. Conclusion:This study supports the notion that there is a positive relationship between an increase in the dynamic response and the risk for more serious brain injury. Peak resultant linear acceleration may be more related to SDH meanwhile rotational acceleration may be more related to severity of concussion. Despite SDH being the more severe brain injury, on average this group 4 had the lowest values for stress and strain as compared to concussion and PPCS. Finite element analysis of the SDH injuries examined brain tissue values for the group of elements in the model than corresponded to the location of the bleed which may not be reflective of the highest values if the entire cerebrum was considered. More importantly, SDH injuries are vascular injuries and may not necessarily result in damage to the brain. In summary, this study found that the dynamic response of an impact is reflective of injury severity. Understanding the relationship between the dynamic response and the nature of the injury provides important information for developing strategies for injury prevention. 5 DefinitionsBulk Modulus -is a measure of the compressibility of a material in Pascal Decay Constant -a rate constant t...

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Postconcussive symptoms after uncomplicated mild head injury

Cited by 273 publications

References 0 publications

Postconcussion syndrome: demographics and predictors in 221 patients

Postconcussion syndrome: demographics and predictors in 221 patients

Traumatic Brain Injuries Evaluated in U.S. Emergency Departments, 1992‐1994

A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma

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