In a multicenter cohort study of 803 patients who visited the emergency department with mild traumatic brain injury, investigators identified nine early characteristics associated with symptoms that persisted 30 days following injury.
Based on the Rivermead Post Concussion Symptoms Questionnaire, 29% of patients continued to experience symptoms at day 30. Female patients were more affected compared with male patients (37% vs 22%). Headache was the most common symptom, reported by 74% of the patients at presentation and decreasing to 50% after 1 month.
The characteristics associated with persistent symptoms included female sex; higher body mass index; and injuries from falls, vehicular crashes, or abuse. The patients with a history of headaches, migraines, depression, or anxiety also had a greater likelihood of ongoing symptoms. Focal neurologic deficits, headaches at presentation, and multiple computed tomography (CT) scans were additional predictors of symptom persistence.
“[P]atients identified as highly likely to experience persistent 30-day postconcussive symptoms could be candidates for early intervention. Risk assessment timing is important, because early interventions are those most likely to have the greatest impact on subsequent function,” said lead study author W. Frank Peacock, MD, of the Baylor College of Medicine, and colleagues.
The median patient age was 41 years, and slightly more than 50% were male. Most injuries resulted from falls or being struck by an object, followed by vehicular crashes. Just 13% of the patients presented to the emergency department (ED) more than 24 hours following injury, with a median interval of 1.5 hours. At presentation, 82% reported headache, 64% had trauma above the clavicle, 55% reported dizziness, and 39% reported confusion.
The findings came from HeadSMART II, a prospective, multicenter observational study that began enrollment in 2021. Adult patients aged 18 years or older who presented within 96 hours of head injury were included. A confirmed mild traumatic brain injury (mTBI) diagnosis was established at 30 days using 2023 American Congress of Rehabilitation Medicine criteria. Patients completed neurocognitive testing and questionnaires at presentation and again at days 14, 30, and 90.
The investigators used logistic regression to analyze baseline variables associated with 30-day symptom persistence. Statistical adjustments controlled for multiple comparisons, and odds ratios were calculated to measure the strength of associations.
The study had several limitations. The follow-up period was limited to 30 days, and outcomes were based on patient-reported symptoms without objective biomarkers. The analysis was retrospective within an observational data set and didn't include multivariable predictive modeling. Because of these factors, causation couldn't be determined, and the investigators stated that their findings shouldn't be used to guide treatment decisions.
The investigators noted that recognizing early demographic and clinical indicators of postconcussion symptoms may aid in developing prognostic models and refining trial designs for future interventions. The study underscored the importance of early ED evaluation to identify patients most at risk for prolonged recovery following mTBI, a step that could ultimately enhance long-term care strategies.
The study didn't report funding sources or conflicts of interest.
Source: JAMA Network Open
