Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department

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.

Résumé

Objectifs

Identifier les facteurs de risque associés aux symptômes persistants consécutifs à une commotion cérébrale chez les adultes se présentant au service des urgences avec un traumatisme cranio-cérébral aiguë.

Méthodes

Il s'agissait d'une analyse secondaire d'un essai contrôlé randomisé mené dans trois services d'urgence Canadien, dans lequel l'intervention n'a eu aucun impact sur le rétablissement ou les conséquences d'utilisation des soins de santé. L'essai clinique a été effectuée sur les patients adultes (âgés de 18 à 64 ans) avec un traumatisme cranio-cérébral léger (TCCL) soutenu dans les 48 heures précédentes. Le critère principal de jugement était la présence des symptômes de traumatisme crânien 30 jours après la commotion, définie comme la présence d'au moins 3 symptômes dans le questionnaire Rivermead sur les symptômes post-commotionnels.

Résultats

Parmi les 241 patients qui ont terminé le suivi, l'âge médian (EI) était de 33 ans (25 à 50) et 147 (61,0 %) étaient des femmes. À 30 jours, 49 (20,3 %) présentaient des symptômes persistants. En utilisant une régression logistique multivariée, des maux de tête à la présentation aux services d'urgence (OR: 7,7; IC à 95 % : 1,6 à 37,8), être sous l'influence de drogues ou d'alcool au moment de la commotion (OR : 5,9; IC à 95 % : 1,8 à 19,4), la blessure survenue à la suite d'une collision à vélo ou à moteur (OR : 2,9; IC à 95 %: 1,3 à 6,0), des antécédents d'anxiété ou de dépression (OR : 2,4; IC à 95 % : 1,2 à 4,9) et un engourdissement ou des picotements lors de la présentation aux services d'urgence (OR : 2,4; IC à 95 % : 1,1 à 5,2), se sont avérés être indépendamment associés aux symptômes persistants consécutifs à une commotion cérébrale à 30 jours

Conclusions

Cinq variables se sont révélées être des indicateurs significatifs des symptômes persistants consécutifs à une commotion cérébrale. Bien que le TCCL soit principalement une condition auto-limitée, les patients présentant ces facteurs de risque doivent être considérés comme à haut risque de développer des symptômes persistants et signalés pour un suivi ambulatoire précoce

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Funding

This project was supported by grants from the Workplace Safety and Insurance Board of Ontario and the Canadian Association of Emergency Physicians.

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CV contributed to study concept and design, interpretation of the data, drafting and editing the manuscript, and acquisition of funding. CT contributed to acquisition of the data, data analysis and interpretation, critical revision of the manuscript, and statistical expertise. KD contributed to study design, acquisition of data, and editing the manuscript. BB contributed to study concept and design and editing the manuscript. RH contributed to study design and acquisition of the data. SM contributed to study concept and design, acquisition of funding, data analysis and interpretation, and editing the manuscript.

Corresponding author

Correspondence to Catherine Varner.

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CV, CT, KD, BB, RH, and SM report no conflict of interest

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Varner, C., Thompson, C., de Wit, K. et al. Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department. Can J Emerg Med (2021). https://doi.org/10.1007/s43678-020-00076-6

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Keywords

  • Mild traumatic brain injury
  • Concussion
  • Persistent concussion symptoms