Postconcussive Symptoms Over the First 14 Days After Mild Traumatic Brain Injury: An Experience Sampling Study

• Published in: The journal of head trauma rehabilitation Vol. 33; no. 3; pp. E31 - E39
• Main Authors: Pacella, Maria, Prabhu, Arjun, Morley, Julia, Huang, Stephanie, Suffoletto, Brian
• Format: Journal Article
• Language: English
• Published: United States 01-05-2018
• Subjects: Adolescent; Adult; Age Factors; Anxiety - epidemiology; Anxiety - etiology; Anxiety - physiopathology; Brain Concussion - complications; Brain Concussion - diagnosis; Brain Concussion - therapy; Cognition Disorders - epidemiology; Cognition Disorders - etiology; Cognition Disorders - physiopathology; Emergency Service, Hospital - statistics & numerical data; Female; Follow-Up Studies; Headache - epidemiology; Headache - etiology; Headache - physiopathology; Humans; Incidence; Injury Severity Score; Male; Middle Aged; Neuropsychological Tests; Pennsylvania; Post-Concussion Syndrome - etiology; Post-Concussion Syndrome - physiopathology; Post-Concussion Syndrome - therapy; Recovery of Function; Retrospective Studies; Sampling Studies; Severity of Illness Index; Sex Factors; Time Factors; Treatment Outcome; Urban Population; Young Adult; Pennsylvania
• ISSN: 0885-9701; 1550-509X
• DOI: 10.1097/HTR.0000000000000335

This study examined changes in postconcussive symptoms (PCS) over the acute postinjury recovery period, focusing on how daily PCSs differ between mild traumatic brain injury (mTBI) and other injury types.
An urban emergency department (ED) in Western Pennsylvania.
A total of 108 adult patients with trauma being discharged from the ED were recruited and grouped by injury type: mild TBI (mTBI; n = 39), head injury without mTBI (HI: n = 16), and non-head-injured trauma controls (TCs: n = 53).
Subjects completed a baseline assessment and an experience sampling method (ESM) protocol for 14 consecutive days postinjury: outcomes were daily reports of headaches, anxiety, and concentration difficulties.
Controlling for confounders, multilevel modeling revealed greater odds of headache and concentration difficulties on day 1 postinjury among the HI and mTBI groups (vs TCs). These odds decreased over time, with greater reductions for the HI and mTBI groups compared with TCs. By day 14, there were no group differences in PCS. In addition, only the HI group reported higher initial levels of anxiety and a steeper slope relative to TCs.
Patients with HI, regardless of whether they meet the American Congress of Rehabilitation Medicines definition of mTBI, have higher odds of typical PCS immediately postinjury, but faster rates of recovery than TCs. ESM can improve understanding the dynamic nature of postinjury PCS.