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Mild Traumatic Brain Injury: Studies on outcome and prognostic factors
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
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 [en]
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: urn:nbn:se:uu:diva-180326ISBN: 978-91-554-8464-4 (print)OAI: oai:DiVA.org:uu-180326DiVA: diva2:549222
Public defence
2012-10-18, Brömssalen, Gävle sjukhus, Gävle, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2012-09-27 Created: 2012-09-03 Last updated: 2013-01-23
List of papers
1. Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort
Open this publication in new window or tab >>Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort
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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.

Keyword
Mild traumatic brain injury, post-concussion symptoms, rivermead post-concussion, symptoms, questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-125599 (URN)10.1080/02699050902748356 (DOI)000263267100004 ()19205957 (PubMedID)
Available from: 2010-05-24 Created: 2010-05-24 Last updated: 2012-09-28Bibliographically approved
2. Internal construct validity of the Rivermead Post-Concussion Symptoms Questionnaire
Open this publication in new window or tab >>Internal construct validity of the Rivermead Post-Concussion Symptoms Questionnaire
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2011 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, no 11, 997-1002 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the internal construct validity of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) by Rasch analysis of data from a national cohort of patients with mild traumatic brain injury.

METHODS: Data collected at 3 months after mild traumatic brain injury from 2,523 patients were analysed using the partial credit model, describing rating scale structure, local dependency, age and gender differential functioning, dimensionality and model fit.

RESULTS: Categories did not work in a consistent manner; however, collapsing of Categories 1 and 2 yielded ordered thresholds. Local dependency of items was present and 2 item pairs were combined. There was no differential item functioning by gender or age. The Rasch factor explained 47.7% of the variance and the first contrast explained 12.4% of the unexplained variance (eigenvalue 1.9). Further analysis indicated 3 or more dimensions. Person measure had a mean of -2.16, showing poor targeting of persons to items. Person reliability was 0.71 and person separation index was 1.56.

CONCLUSION: According to this Rasch analysis of data from a representative sample of mild traumatic brain injury, the RPQ may not be optimal for this population. Even after reducing the number of categories and collapsing items with local dependency, unidimensionality was not reached, which argues against summation of a total score. However, the scale is unbiased for gender and age.

National Category
Other Clinical Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:uu:diva-161396 (URN)10.2340/16501977-0875 (DOI)000297658600006 ()22031345 (PubMedID)
Available from: 2011-11-11 Created: 2011-11-11 Last updated: 2017-12-08Bibliographically approved
3. Does head CT scan pathology predict outcome after mild traumatic brain injury?
Open this publication in new window or tab >>Does head CT scan pathology predict outcome after mild traumatic brain injury?
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2013 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 20, no 1, 124-129 p.Article in journal (Refereed) Published
Abstract [en]

Background:

More evidence is needed to forward our understanding of the key determinants of poor outcome after mild traumatic brain injury (MTBI). A large, prospective, national cohort of patients was studied to analyse the effect of head CT scan pathology on the outcome.

Methods:

Thousand two hundred and sixty-two patients with MTBI [Glasgow Coma Scale (GCS) score 15] at 39 emergency departments completed a study protocol including acute head CT scan examination and follow-up by the Rivermead Post Concussion Symptoms Questionnaire (RPQ) and the Glasgow Outcome Scale Extended (GOSE) at 3 months after MTBI. Binary logistic regression was used for the assessment of prediction ability.

Results:

In 751 men (60%) and 511 women (40%), with a mean age of 30 years (median 21, range 6–94), we observed relevant or suspect relevant pathologic findings on acute CT scan in 52 patients (4%). Patients aged below 30 years reported better outcome both with respect to symptoms and GOSE as compared to patients in older age groups. Men reported better outcome than women as regards symptoms (OR 0.64, CI 0.49–0.85 for 3 symptoms) and global function (OR 0.60, CI 0.39–0.92 for GOSE 1–6).

Conclusions:

Pathology on acute CT scan examination had no effect on selfreported symptoms or global function at 3 months after MTBI. Female gender and older age predicted a less favourable outcome. The findings support the view that other factors than brain injury deserve attention to minimize long-term complaints after MTBI.

Keyword
brain concussion, prediction
National Category
Other Clinical Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:uu:diva-180312 (URN)10.1111/j.1468-1331.2012.03813.x (DOI)000314996200019 ()
Available from: 2012-09-03 Created: 2012-09-03 Last updated: 2017-12-07Bibliographically approved
4. Clinical outcome and brain pathology after mild traumatic brain injury: an exploratory study by repeated MR examinations
Open this publication in new window or tab >>Clinical outcome and brain pathology after mild traumatic brain injury: an exploratory study by repeated MR examinations
(English)Manuscript (preprint) (Other academic)
Keyword
Brain concussion; Rivermead post-concussion symptoms questionnaire; Glasgow outcome scale extended
National Category
Other Clinical Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:uu:diva-180313 (URN)
Available from: 2012-09-03 Created: 2012-09-03 Last updated: 2012-09-28

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