John J Leddy1, John G Baker, Asim Merchant, John Picano, Daniel Gaile, Jason Matuszak, Barry Willer. 1. *Department of Orthopaedics, State University of New York at Buffalo, Buffalo, New York; †University Sports Medicine, Department of Orthopaedics, State University of New York at Buffalo, Buffalo, New York; Departments of ‡Nuclear Medicine and Orthopaedics; and §Family Medicine, State University of New York at Buffalo, Buffalo, New York; ¶SUNY Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; ‖Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York; and **Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York.
Abstract
OBJECTIVE: To compare symptoms in patients with physiologic postconcussion disorder (PCD) versus cervicogenic/vestibular PCD. We hypothesized that most symptoms would not be equivalent. In particular, we hypothesized that cognitive symptoms would be more often associated with physiologic PCD. DESIGN: Retrospective review of symptom reports from patients who completed a 22-item symptom questionnaire. SETTING: University-based concussion clinic. PATIENTS: Convenience sample of 128 patients who had symptoms after head injury for more than 3 weeks and who had provocative treadmill exercise testing. INDEPENDENT VARIABLES: Subjects were classified as either physiologic PCD (abnormal treadmill performance and a normal cervical/vestibular physical examination) or cervicogenic/vestibular PCD (CGV, normal treadmill performance, and an abnormal cervical/vestibular physical examination). MAIN OUTCOME MEASURES: Self-reported symptoms. Univariate and multivariate methods, including t tests, tests of equivalence, a logistic regression model, k-nearest neighbor analysis, multidimensional scaling, and principle components analysis were used to see whether symptoms could distinguish PCD from CGV. RESULTS: None of the statistical methods used to analyze self-reported symptoms was able to adequately distinguish patients with PCD from patients with CGV. CONCLUSIONS: Symptoms after head injury, including cognitive symptoms, have traditionally been ascribed to brain injury, but they do not reliably discriminate between physiologic PCD and cervicogenic/vestibular PCD. Clinicians should consider specific testing of exercise tolerance and perform a physical examination of the cervical spine and the vestibular/ocular systems to determine the etiology of postconcussion symptoms. CLINICAL RELEVANCE: Symptoms after head injury, including cognitive symptoms, do not discriminate between concussion and cervical/vestibular injury.
OBJECTIVE: To compare symptoms in patients with physiologic postconcussion disorder (PCD) versus cervicogenic/vestibular PCD. We hypothesized that most symptoms would not be equivalent. In particular, we hypothesized that cognitive symptoms would be more often associated with physiologic PCD. DESIGN: Retrospective review of symptom reports from patients who completed a 22-item symptom questionnaire. SETTING: University-based concussion clinic. PATIENTS: Convenience sample of 128 patients who had symptoms after head injury for more than 3 weeks and who had provocative treadmill exercise testing. INDEPENDENT VARIABLES: Subjects were classified as either physiologic PCD (abnormal treadmill performance and a normal cervical/vestibular physical examination) or cervicogenic/vestibular PCD (CGV, normal treadmill performance, and an abnormal cervical/vestibular physical examination). MAIN OUTCOME MEASURES: Self-reported symptoms. Univariate and multivariate methods, including t tests, tests of equivalence, a logistic regression model, k-nearest neighbor analysis, multidimensional scaling, and principle components analysis were used to see whether symptoms could distinguish PCD from CGV. RESULTS: None of the statistical methods used to analyze self-reported symptoms was able to adequately distinguish patients with PCD from patients with CGV. CONCLUSIONS: Symptoms after head injury, including cognitive symptoms, have traditionally been ascribed to brain injury, but they do not reliably discriminate between physiologic PCD and cervicogenic/vestibular PCD. Clinicians should consider specific testing of exercise tolerance and perform a physical examination of the cervical spine and the vestibular/ocular systems to determine the etiology of postconcussion symptoms. CLINICAL RELEVANCE: Symptoms after head injury, including cognitive symptoms, do not discriminate between concussion and cervical/vestibular injury.
Authors: John J Leddy; Andrea L Hinds; Jeffrey Miecznikowski; Scott Darling; Jason Matuszak; John G Baker; John Picano; Barry Willer Journal: Clin J Sport Med Date: 2018-01 Impact factor: 3.638