When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury

TY - JOUR

T1 - When a minor head injury results in enduring symptoms

T2 - a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury

AU - Hou, Ruihua

AU - Moss-Morris, Rona

AU - Peveler, Robert

AU - Mogg, Karin

AU - Bradley, Brendan P

AU - Belli, Antonio

PY - 2012/2

Y1 - 2012/2

N2 - Objective A significant proportion (15-30%) of patients with mild traumatic brain injury (MTBI) are at risk of developing postconcussional syndrome (PCS). The aim of this study was to investigate the contributions of cognitive, emotional, behavioural and social factors to the development of PCS and identify early predictors. Methods A prospective cohort design was employed. 126 MTBI patients completed baseline questionnaire assessments within 2 weeks of the injury and 107 completed follow-up questionnaire assessments at 3 and 6 months. A series of self-report measures were used to assess cognitive, behavioural and emotional responses to MTBI. The primary outcome was the ICD-10 diagnosis for PCS. Demographic and clinical characteristic variables were compared between PCS cases and non-cases using independent sample t tests and chi(2) tests. Individual and multivariate logistic regression analyses were used to detect predictors of PCS. Results Of 107 MTBI patients, 24 (22%) met the criteria for PCS at 3 months and 22 (21%) at 6 months. Individual logistic regression analysis indicated that negative MTBI perceptions, stress, anxiety, depression and all-or-nothing behaviour were associated with the risk of PCS. Multivariate analysis revealed that all-or-nothing behaviour was the key predictor for the onset of PCS at 3 months while negative MTBI perceptions predicted PCS at 6 months. Conclusions The study provides good support for the proposed cognitive behavioural model. Patients' perceptions of their head injury and their behavioural responses play important roles in the development of PCS, indicating that cognitive and behavioural factors may be potential targets for early preventive interventions.

AB - Objective A significant proportion (15-30%) of patients with mild traumatic brain injury (MTBI) are at risk of developing postconcussional syndrome (PCS). The aim of this study was to investigate the contributions of cognitive, emotional, behavioural and social factors to the development of PCS and identify early predictors. Methods A prospective cohort design was employed. 126 MTBI patients completed baseline questionnaire assessments within 2 weeks of the injury and 107 completed follow-up questionnaire assessments at 3 and 6 months. A series of self-report measures were used to assess cognitive, behavioural and emotional responses to MTBI. The primary outcome was the ICD-10 diagnosis for PCS. Demographic and clinical characteristic variables were compared between PCS cases and non-cases using independent sample t tests and chi(2) tests. Individual and multivariate logistic regression analyses were used to detect predictors of PCS. Results Of 107 MTBI patients, 24 (22%) met the criteria for PCS at 3 months and 22 (21%) at 6 months. Individual logistic regression analysis indicated that negative MTBI perceptions, stress, anxiety, depression and all-or-nothing behaviour were associated with the risk of PCS. Multivariate analysis revealed that all-or-nothing behaviour was the key predictor for the onset of PCS at 3 months while negative MTBI perceptions predicted PCS at 6 months. Conclusions The study provides good support for the proposed cognitive behavioural model. Patients' perceptions of their head injury and their behavioural responses play important roles in the development of PCS, indicating that cognitive and behavioural factors may be potential targets for early preventive interventions.

KW - Craniocerebral Trauma

KW - Young Adult

KW - Emotions

KW - Analysis of Variance

KW - Humans

KW - Mental Disorders

KW - Self Concept

KW - Adult

KW - Treatment Outcome

KW - Social Support

KW - Post-Concussion Syndrome

KW - Brain Injuries

KW - Adolescent

KW - Neuropsychological Tests

KW - Male

KW - Depression

KW - Questionnaires

KW - Cognition Disorders

KW - Prospective Studies

KW - Psychiatric Status Rating Scales

KW - Logistic Models

KW - Risk Factors

KW - Cohort Studies

KW - Follow-Up Studies

KW - Middle Aged

KW - Glasgow Coma Scale

KW - Female

KW - Diagnostic and Statistical Manual of Mental Disorders

U2 - 10.1136/jnnp-2011-300767

DO - 10.1136/jnnp-2011-300767

M3 - Article

C2 - 22028384

SN - 1468-330X

VL - 83

SP - 217

EP - 223

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

IS - 2

ER -