Research Reports - Predictors of postconcussive symptoms 3 months after mild traumatic brain injury

Neuropsychology. 2012 Apr 2.

Ponsford J, Cameron P, Fitzgerald M, Grant M, Mikocka-Walus A, Schönberger M.

Objective: There is continuing controversy regarding predictors of poor outcome
following mild traumatic brain injury (mTBI). This study aimed to prospectively
examine the influence of preinjury factors, injury-related factors, and
postinjury factors on outcome following mTBI. Method: Participants were 123
patients with mTBI and 100 trauma patient controls recruited and assessed in the
emergency department and followed up 1 week and 3 months postinjury. Outcome was
measured in terms of reported postconcussional symptoms. Measures included the
ImPACT Post-Concussional Symptom Scale and cognitive concussion battery,
including Attention, Verbal and Visual memory, Processing Speed and Reaction Time
modules, pre- and postinjury SF-36 and MINI Psychiatric status ratings, VAS Pain
Inventory, Hospital Anxiety and Depression Scale, PTSD Checklist-Specific, and
Revised Social Readjustment Scale. Results: Presence of mTBI predicted
postconcussional symptoms 1 week postinjury, along with being female and
premorbid psychiatric history, with elevated HADS anxiety a concurrent indicator.
However, at 3 months, preinjury physical or psychiatric problems but not mTBI
most strongly predicted continuing symptoms, with concurrent indicators including
HADS anxiety, PTSD symptoms, other life stressors and pain. HADS anxiety and age
predicted 3-month PCS in the mTBI group, whereas PTSD symptoms and other life
stressors were most significant for the controls. Cognitive measures were not
predictive of PCS at 1 week or 3 months. Conclusions: Given the evident influence
of both premorbid and concurrent psychiatric problems, especially anxiety, on
postinjury symptoms, managing the anxiety response in vulnerable individuals with
mTBI may be important to minimize ongoing sequelae.

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