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Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
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2009 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 23, no 3, 213-219 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES

To describe symptom prevalence and structure after mild traumatic brain injury (MTBI) in a population-based cohort.

METHODS

Symptoms data were collected at 3 months post-MTBI by use of the Rivermead Post-concussion Symptoms Questionnaire (RPQ) at follow-up of 2602 patients attending 39 Swedish hospitals. Spearmans rank correlation analysis was used to explore correlations between symptoms and structural equation modelling (SEM) was performed by use of several fit indices to explore if data were compatible with one or more factors.

RESULTS

Questionnaires were received from 2523 (97%) patients with a mean age of 31 years (median 22, range 6-96). A majority of the respondents (56%) reported no remaining injury related symptoms, 24% reported three or more symptoms and 10% reported seven or more symptoms. All symptoms exhibited strong positive inter-relations and SEM provided strong support for a single or two factor solution. Fit indices were only slightly weaker for three and four factor solutions.

CONCLUSIONS

A significant minority of patients reported multiple symptoms to persist at 3 months after MTBI. The observed structure of symptoms according to RPQ demonstrates a common factor for all symptoms, but also sub-groups of symptoms as previously suggested.

Place, publisher, year, edition, pages
2009. Vol. 23, no 3, 213-219 p.
Keyword [en]
Mild traumatic brain injury, post-concussion symptoms, rivermead post-concussion, symptoms, questionnaire
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-125599DOI: 10.1080/02699050902748356ISI: 000263267100004PubMedID: 19205957OAI: oai:DiVA.org:uu-125599DiVA: diva2:320335
Available from: 2010-05-24 Created: 2010-05-24 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Mild Traumatic Brain Injury: Studies on outcome and prognostic factors
Open this publication in new window or tab >>Mild Traumatic Brain Injury: Studies on outcome and prognostic factors
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: To explore the prevalence and structure of self-reported disability after mild traumatic brain injury and the impact of traumatic brain pathology on such outcome.

Material and methods: In study 1-3, symptoms data were collected by use of Rivermead Post-concussion Symptoms Questionnaire (RPQ) and data on global function by use of Glasgow Outcome Scale Extended (GOSE) from 2602 patients at 3 months after MTBI. RPQ data were subject to factor and Rasch-analyses Head CT data from 1262 patients were used in a prediction analysis that also included age and gender. In study 4, MRI and symptoms data were collected at 2-3 days and at 3-7 months follow-up after MTBI in 19 patients. Global function was assessed at follow-up by use of the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ) and GOSE.

Results: I. Most respondents reported no remaining symptoms but 24% reported ≥3 and 10% ≥7 remaining symptoms. The factor analysis demonstrated that all symptoms are correlated but also identified subgroups of symptoms. II. Rasch-analysis of RPQ showed disordered category function, local dependency of items, poor targeting of persons to items and indications of 3 or more dimensions. There was no differential item functioning. III. Head CT pathology with no need for acute intervention was observed in 52 patients (4%) but was not associated with either frequency of remaining symptoms or global outcome at 3 months post injury. Female gender and age over 30 years were associated with less favourable outcome with respect to symptoms and GOSE. IV. Post-acute MRI indicated trauma-related pathology in one patient and follow-up MRI indicated loss of brain volume in 4 patients.

Conclusions: A substantial proportion of patients with MTBI report remaining problems at three months after MTBI. RPQ is useful but not optimal to assess symptoms outcome after MTBI and calculation of a total sum score is not recommended. Female gender and older age are negative prognostic factors while brain pathology according to CT has no effect on self-reported outcome. Loss of brain volume after MTBI according to MRI may be a sensitive marker of traumatic brain pathology and deserves further studies.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 43 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 810
Keyword
Rehabilitation, Mild Traumatic Brain Injury, Rivermead Post-concussion Symptoms Questionnaire, Rasch-analysis, prediction, outcome, head CT pathology, Magnet Resonance Imaging
National Category
Other Clinical Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:uu:diva-180326 (URN)978-91-554-8464-4 (ISBN)
Public defence
2012-10-18, Brömssalen, Gävle sjukhus, Gävle, 13:15 (Swedish)
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Available from: 2012-09-27 Created: 2012-09-03 Last updated: 2013-01-23

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