PDF
ePub
Citation
Print
Abstract
Objective
We investigated independent predictors of post-concussion syndrome after mild head injury.
Methods
From January 2001 to December 2007, 66 consecutive patients were diagnosed as post-concussion syndrome among 331 patients with mild head injury admitted to our neurosurgical department. We reviewed retrospectively the medical records and analyzed baseline and socioeconomic data including age, sex, current smoking, alcohol consumption, level of education, employment status, marital status and types of injury. Using multivariate analysis, we evaluated possible factors associated with post-concussion syndrome after mild head injury.
Results
The incidence of post-concussion syndrome after mild head injury was 19.9%. Patient's unemployed state was significantly higher among patients with post-concussion syndrome than in the control group (39.4% versus 23.4%, respectively, p=0.008) and the victims of traffic accident were more frequent among patients with post-concussion syndrome than in the control group (81.8% versus 55.1%, respectively, p<0.001). Multivariate analysis showed that unemployed state (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.24-4.32, p=0.008), divorced state (OR 2.06, 95% CI 1.06-4.00, p=0.034) and the victims of traffic accident (OR 4.87, 95% CI 2.09-11.34, p<0.001) are independently associated with post-concussion syndrome after mild head injury.
REFERENCES
1. Alexander MP. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995; 45:1253–1260.
2. Begaz T, Kyriacou DN, Segal J, Bazarian JJ. Serum biochemical markers for post-concussion syndrome in patients with mild traumatic brain injury. J Neurotrauma. 2006; 23:1201–1210.
3. Binder LM. A review of mild head trauma. Part II: Clinical implications. J Clin Exp Neuropsychol. 1997; 19:432–457.
4. Binder LM. Persisting symptoms after mild head injury: a review of the postconcussive syndrome. J Clin Exp Neuropsychol. 1986; 8:323–346.
5. Boake C, McCauley SR, Levin HS, Contant CF, Song JX, Brown SA, et al. Limited agreement between criteria-based diagnoses of postconcussional syndrome. J Neuropsychiatry Clin Neurosci. 2004; 16:493–499.
6. Bohnen N, Jolles J. Neurobehavioral aspects of postconcussive symptoms after mild head injury. J Nerv Ment Dis. 1992; 180:683–692.
7. Bohnen N, Jolles J, Twijnstra A. Neuropsychological deficits in patients with persistent symptoms six months after mild head injury. Neurosurgery. 1992; 30:692–695.
8. Bohnen N, Twijnstra A, Jolles J. Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury. Brain Inj. 1992; 6:481–487.
9. Bohnen N, Van Zutphen W, Twijnstra A, Wijnen G, Bongers J, Jolles J. Late outcome of mild head injury: results from a controlled postal survey. Brain Inj. 1994; 8:701–708.
10. Chen SH, Kareken DA, Fastenau PS, Trexler LE, Hutchins GD. A study of persistent post-concussion symptoms in mild head trauma using positron emission tomography. J Neurol Neurosurg Psychiatry. 2003; 74:326–332.
11. Dixon CE, Taft WC, Hayes RL. Mechanisms of mild traumatic brain injury. J Head Trauma Rehabil. 1993; 8:1–12.
12. Evans RW. The postconcussion syndrome and the sequelae of mild head injury. Neurol Clin. 1992; 10:815–847.
13. Gasquoine PG. Postconcussion symptoms. Neuropsychol Rev. 1997; 7:77–85.
14. Haboubi NH, Long J, Koshy M, Ward AB. Short-term sequelae of minor head injury (6 years experience of minor head injury clinic). Disabil Rehabil. 2001; 23:635–638.
15. Ingebrigtsen T, Romner B, Marup-Jensen S, Dons M, Lundqvist C, Bellner J, et al. The clinical value of serum S-100 protein measurements in minor head injury: a Scandinavian multicentre study. Brain Inj. 2000; 14:1047–1055.
16. Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol. 2006; 21:303–310.
17. King NS. Emotional, neuropsychological, and organic factors: their use in the prediction of persisting postconcussion symptoms after moderate and mild head injuries. J Neurol Neurosurg Psychiatry. 1996; 61:75–81.
18. Kurca E, Sivák S, Kucera P. Impaired cognitive functions in mild traumatic brain injury patients with normal and pathologic magnetic resonance imaging. Neuroradiology. 2006; 48:661–669.
19. Leininger BE, Gramling SE, Farrell AD, Kreutzer JS, Peck EA 3rd. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psychiatry. 1990; 53:293–296.
20. Levin HS, Amparo E, Eisenberg HM, Williams DH, High WM Jr, McArdle CB, et al. Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg. 1987; 66:706–713.
21. Long CJ, Webb WL Jr. Psychological sequelae of head trauma. Psychiatr Med. 1983; 1:35–77.
22. Mattson AJ, Levin HS. Frontal lobe dysfunction following closed head injury. A review of the literature. J Nerv Ment Dis. 1990; 178:282–291.
23. McCauley SR, Boake C, Pedroza C, Brown SA, Levin HS, Goodman HS, et al. Postconcussional disorder: Are the DSM-IV criteria an improvement over the ICD-10? J Nerv Ment Dis. 2005; 193:540–550.
24. McCrea M, Kelly JP, Randolph C, Cisler R, Berger L. Immediate neurocognitive effects of concussion. Neurosurgery. 2002; 50:1032–1040.
25. McKinlay WW, Brooks DN, Bond MR. Post-concussional symptoms, financial compensation and outcome of severe blunt head injury. J Neurol Neurosurg Psychiatry. 1983; 46:1084–1091.
26. Meares S, Shores EA, Batchelor J, Baguley IJ, Chapman J, Gurka J, et al. The relationship of psychological and cognitive factors and opioids in the development of the postconcussion syndrome in general trauma patients with mild traumatic brain injury. J Int Neuropsychol Soc. 2006; 12:792–801.
27. Miller H. Accident neurosis. Br Med J. 1961; 1:992–998.
28. Mittenberg W, DiGiulio DV, Perrin S, Bass AE. Symptoms following mild head injury: expectation as etiology. J Neurol Neurosurg Psychiatry. 1992; 55:200–204.
29. Mittenberg W, Tremont G, Zielinski RE, Fichera S, Rayls KR. Cognitive-behavioral prevention of postconcussion syndrome. Arch Clin Neuropsychol. 1996; 11:139–145.
30. Paniak C, Toller-Lobe G, Reynolds S, Melnyk A, Nagy J. A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. Brain Inj. 2000; 14:219–226.
31. Ponsford J, Willmott C, Rothwell A, Cameron P, Kelly AM, Nelms R, et al. Impact of early intervention on outcome following mild head injury in adults. J Neurol Neurosurg Psychiatry. 2002; 73:330–332.
32. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery. 1981; 9:221–228.
33. Ruff RM, Crouch JA, Tröster AI, Marshall LF, Buchsbaum MS, Lottenberg S, et al. Selected cases of poor outcome following a minor brain trauma: comparing neuropsychological and positron emission tomography assessment. Brain Inj. 1994; 8:297–308.
34. Savola O, Hillbom M. Early predictors of post-concussion symptoms in patients with mild head injury. Eur J Neurol. 2003; 10:175–181.
35. Szymanski HV, Linn R. A review of the postconcussion syndrome. Int J Psychiatry Med. 1992; 22:357–375.
36. Warriner EM, Rourke BP, Velikonja D, Metham L. Subtypes of emotional and behavioural sequelae in patients with traumatic brain injury. J Clin Exp Neuropsychol. 2003; 25:904–917.
Table 1.
Baseline characteristics of 66 consecutive patients with post-concussion syndrome after mild head injury
Table 2.
Symptoms of 66 patients with post-concussion syndrome after mild head injury
Table 3.
Multivariate logistic regression analysis
| Variables | Odds ratio (95% CI)* | p-value |
|---|---|---|
| Women | 1.39 (0.77-2.52) | 0.281 |
| Unemployed state | 2.32 (1.24-4.32) | 0.008 |
| Marital status | ||
| Married | 1 | |
| Divorced | 2.06 (1.06-4.00) | 0.034 |
| Single or others | 0.80 (0.34-1.88) | 0.603 |
| Type of injury | ||
| Traffic accident (victim) | 4.87 (2.09-11.34) | <0.001 |
| Slip down or fall down | 1.96 (0.57-6.75) | 0.285 |
| Traffic accident (Wrongdoer) | 1 |
XML Download