Emergency department assessment of mild traumatic brain injury and the prediction of postconcussive symptoms: a 3-month prospective study

J Head Trauma Rehabil. 2009 Sep-Oct;24(5):333-43. doi: 10.1097/HTR.0b013e3181aea51f.

Abstract

Objective: To investigate the utility of a brief emergency department (ED) bedside screen for the prediction of postconcussive symptoms at 3 months following mild traumatic brain injury (MTBI).

Participants: One hundred patients with MTBI (78% men; mean age = 33.6 years); 2 control groups (each n = 100), a "minor nonhead injury" group (77% men; mean age = 32.2 years) and an "uninjured ED visitor" group (78% men; mean age = 33.6 years).

Main measures: Brief measures of neuropsychological functioning, acute pain, and postural stability were collected in the ED; telephone follow-up at 3 months using the Rivermead Post-Concussion Symptoms Questionnaire was undertaken.

Results: Neuropsychological deficits, acute pain, and postural instability in the ED were significantly associated with postconcussive symptoms at 3-month follow-up. A regression formula using 3 easily obtainable measures obtained during acute stage of injury-immediate and delayed memory for 5 words and a visual analog scale score of acute headache-provided 80% sensitivity and 76% specificity for the prediction of clinically significant symptoms at 3 months postinjury.

Conclusion: A small combination of variables assessable in the ED may predict MTBI patients likely to experience persistent postconcussive symptoms.

MeSH terms

  • Adult
  • Brain Concussion / diagnosis*
  • Brain Concussion / psychology
  • Brain Concussion / rehabilitation
  • Emergency Service, Hospital*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mass Screening*
  • Neurologic Examination / statistics & numerical data
  • Neuropsychological Tests / statistics & numerical data
  • New South Wales
  • Pain Measurement / statistics & numerical data
  • Post-Concussion Syndrome / diagnosis*
  • Post-Concussion Syndrome / psychology
  • Post-Concussion Syndrome / rehabilitation
  • Postural Balance
  • Prognosis
  • Prospective Studies
  • Psychometrics
  • Rehabilitation, Vocational
  • Risk Assessment
  • Young Adult