Influence of concomitant injuries on post-concussion symptoms after a mild traumatic brain injury – a prospective multicentre cohort study

ABSTRACT

Objectives: To compare post-concussion symptoms (PCS) and return to normal activities between mild Traumatic Brain Injury (mTBI) patients with or without concomitant injuries at 7-and 90 days post-mTBI.Methods: Design: Sub-analysis of a multicentre prospective cohort study. Participants and setting: patients with mTBI from 7 Canadian Emergency Departments. Procedure: Research assistants conducted telephone follow-ups using the Rivermead Postconcussion Symptoms Questionnaire (RPQ) at 7-, 30- and 90 days post-mTBI. Main outcome: Presence of PCS (RPQ: ≥3 symptoms) at 90 days. Secondary outcomes: RPQ score ≥21, prevalence of individual RPQ symptoms and patients’ return to normal activities, at 7- and 90-days. Adjusted risk ratios (RR) were calculated.Results: 1725 mTBI patients were included and 1055 (61.1%) had concomitant injuries. Patients with concomitant injuries were at higher risk of having ≥3 symptoms on the RPQ (RR:1.26 [95% CI 1.01–1.58]) at 90 days. They were also at higher risk of experiencing specific symptoms (dizziness, fatigue, headaches and taking longer to think) and of non-return to their normal activities (RR:2.11 [95% CI 1.30–3.45]).Conclusion: Patients with concomitant injuries have slightly more PCS and seemed to be at higher risk of non-return to their normal activities 90 days, compared to patients without concomitant injuries.

KEYWORDS:

• Brain injuries
• concomitant injuries
• post-concussion symptoms
• rivermead post-concussion symptoms questionnaire

Acknowledgments

We are deeply indebted to all the patients who participated in this study and gratefully acknowledge the emergency physicians at the study sites who recruited the patients and the emergency medicine residents who helped in this process. We acknowledge the following members of our research team: Quebec site – Marilyne Dufresne, Martin Roy, Catherine Bédard and Suzy Lavoie; Lévis site – Lise Lavoie and Josée Jolicoeur; Trois-Rivières site – Émilie Gouin and Annie Cossette; Montreal site – Chantal Lanthier, Tanya Leduc and Catherine Perreault-Légaré; Ottawa site – Connor Sheehan.

Sponsor/Funding

This study was funded by the Canadian Institutes of Health Research.

Author contributions

NLS had full access to all of the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. NLS, VO, VB & XN were responsible for design and conduct of the study. VO, VB, and NLS wrote the manuscript. XN, VO and NLS led the statistical analyses and data interpretation. FB, XN, PA, SB JMC, EDG, ME, JF, EL, JL, ÉM, LM, MCO and JP critically reviewed and approved the manuscript.

Conflicts of interest: None