Catherine Varner1,2,3,4, Cameron Thompson5,6, Kerstin de Wit7, Bjug Borgundvaag8,5,9,6, Reaves Houston5, Shelley McLeod8,5,9,6. 1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. catherine.varner@sinaihealth.ca. 2. Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada. catherine.varner@sinaihealth.ca. 3. Department of Family and Community Medicine, University of Toronto, 206-600 University Avenue, Toronto, ON, M5G 1X5, Canada. catherine.varner@sinaihealth.ca. 4. Sinai Health System, Toronto, ON, Canada. catherine.varner@sinaihealth.ca. 5. Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada. 6. Sinai Health System, Toronto, ON, Canada. 7. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. 8. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 9. Department of Family and Community Medicine, University of Toronto, 206-600 University Avenue, Toronto, ON, M5G 1X5, Canada.
Abstract
OBJECTIVE: To identify risk factors associated with persistent concussion symptoms in adults presenting to the emergency department (ED) with acute mild traumatic brain injury (TBI). METHODS: This was a secondary analysis of a randomized controlled trial conducted in three Canadian EDs whereby the intervention had no impact on recovery or healthcare utilization outcomes. Adult (18-64 years) patients with a mild TBI sustained within the preceding 48 h were eligible for enrollment. The primary outcome was the presence of persistent concussion symptoms at 30 days, defined as the presence of ≥ 3 symptoms on the Rivermead Post-concussion Symptoms Questionnaire. RESULTS: Of the 241 patients who completed follow-up, median (IQR) age was 33 (25 to 50) years, and 147 (61.0%) were female. At 30 days, 49 (20.3%) had persistent concussion symptoms. Using multivariable logistic regression, headache at ED presentation (OR: 7.7; 95% CI 1.6 to 37.8), being under the influence of drugs or alcohol at the time of injury (OR: 5.9; 95% CI 1.8 to 19.4), the injury occurring via bike or motor vehicle collision (OR: 2.9; 95% CI 1.3 to 6.0), history of anxiety or depression (OR: 2.4; 95% CI 1.2 to 4.9), and numbness or tingling at ED presentation (OR: 2.4; 95% CI 1.1 to 5.2), were found to be independently associated with persistent concussion symptoms at 30 days. CONCLUSIONS: Five variables were found to be significant predictors of persistent concussion symptoms. Although mild TBI is mostly a self-limited condition, patients with these risk factors should be considered high risk for developing persistent concussion symptoms and flagged for early outpatient follow-up.
RCT Entities:
OBJECTIVE: To identify risk factors associated with persistent concussion symptoms in adults presenting to the emergency department (ED) with acute mild traumatic brain injury (TBI). METHODS: This was a secondary analysis of a randomized controlled trial conducted in three Canadian EDs whereby the intervention had no impact on recovery or healthcare utilization outcomes. Adult (18-64 years) patients with a mild TBI sustained within the preceding 48 h were eligible for enrollment. The primary outcome was the presence of persistent concussion symptoms at 30 days, defined as the presence of ≥ 3 symptoms on the Rivermead Post-concussion Symptoms Questionnaire. RESULTS: Of the 241 patients who completed follow-up, median (IQR) age was 33 (25 to 50) years, and 147 (61.0%) were female. At 30 days, 49 (20.3%) had persistent concussion symptoms. Using multivariable logistic regression, headache at ED presentation (OR: 7.7; 95% CI 1.6 to 37.8), being under the influence of drugs or alcohol at the time of injury (OR: 5.9; 95% CI 1.8 to 19.4), the injury occurring via bike or motor vehicle collision (OR: 2.9; 95% CI 1.3 to 6.0), history of anxiety or depression (OR: 2.4; 95% CI 1.2 to 4.9), and numbness or tingling at ED presentation (OR: 2.4; 95% CI 1.1 to 5.2), were found to be independently associated with persistent concussion symptoms at 30 days. CONCLUSIONS: Five variables were found to be significant predictors of persistent concussion symptoms. Although mild TBI is mostly a self-limited condition, patients with these risk factors should be considered high risk for developing persistent concussion symptoms and flagged for early outpatient follow-up.
Authors: John J Leddy; Mohammad N Haider; Michael J Ellis; Rebekah Mannix; Scott R Darling; Michael S Freitas; Heidi N Suffoletto; Jeff Leiter; Dean M Cordingley; Barry Willer Journal: JAMA Pediatr Date: 2019-04-01 Impact factor: 16.193
Authors: Andy S Jagoda; Jeffrey J Bazarian; John J Bruns; Stephen V Cantrill; Alisa D Gean; Patricia Kunz Howard; Jamshid Ghajar; Silvana Riggio; David W Wright; Robert L Wears; Aric Bakshy; Paula Burgess; Marlena M Wald; Rhonda R Whitson Journal: Ann Emerg Med Date: 2008-12 Impact factor: 5.721
Authors: Anne Marie Plass; Dominique Van Praag; Amra Covic; Anastasia Gorbunova; Ruben Real; Nicole von Steinbuechel Journal: PLoS One Date: 2019-10-24 Impact factor: 3.240