COMPARING PEOPLE WITH PERSISTING POST-CONCUSSION SYMPTOMS FROM AN EMERGENCY DEPARTMENT-BASED RESEARCH SAMPLE WITH PATIENTS IN A CLINICAL REHABILITATION SAMPLE: AN EXPLORATIVE, RETROSPECTIVE ANALYSIS

TL;DR

This study compares people with long-lasting concussion symptoms from emergency departments and rehabilitation clinics, finding that those in rehab have more severe symptoms and worse outcomes.

Contribution

The study reveals differences in symptom severity and outcomes between emergency department and rehabilitation clinic patients with post-concussion symptoms.

Findings

Rehabilitation clinic patients had higher RPQ scores and more severe symptoms.

Fewer rehabilitation patients had returned to work or school compared to emergency department patients.

Results suggest emergency department data may not reflect rehab patients' experiences.

Abstract

To compare characteristics of people with persisting post-concussion symptoms in a sample referred for treatment and in a sample from a prospective research study.

Observational study.

Participants, aged 18–60 years, with persisting post-concussion symptoms 3–18 months after mild head injury, 92 with mild traumatic brain injury followed from the emergency department (“prospective emergency department sample”) and 106 patients with either mild traumatic brain injury or minimal head injury, referred to an outpatient rehabilitation clinic (“clinical rehabilitation sample”).

Persisting post-concussion symptoms were defined as having British Columbia Post-Concussion Symptom Inventory scores indicating at least moderate persisting post-concussion symptoms and/or Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores ≥ 12. Symptoms, functional outcome, work/school participation, resilience, and fatigue were examined at 3–18 months post injury.

Compared with the prospective emergency department sample, the clinical rehabilitation sample had higher education, higher RPQ scores (30 vs 17), lower Glasgow Outcome Scale Extended scores (median 6 vs 7), and more had not returned to work or school (43% vs 18%).

Treatment-seeking patients with persisting post-concussion symptoms differed in clinically important ways from people who developed persisting post-concussion symptoms in an emergency department-based mild traumatic brain injury study. Results from studies of mild traumatic brain injury seen in the emergency department may not generalize to patients seeking specialized treatment for persisting post-concussion symptoms.

Having persisting symptoms after mild head trauma, referred to as persisting post-concussion symptoms, is not rare, yet the condition remains poorly understood. To provide better treatment, we need to accumulate knowledge on the individuals in need of healthcare for persisting post-concussion symptoms. Findings from studies of patients seen in emergency departments after an acute mild head injury may not be representative for patients seen in other settings, such as rehabilitation clinics. This study compared 2 different groups of individuals with persisting post-concussion symptoms, 1 comprising patients referred for treatment at a specialized rehabilitation clinic and 1 comprising individuals followed from an Emergency Department. We found that the patients referred to the rehabilitation clinic had more severe symptoms and more difficulties in daily life after injury, despite having sustained a milder injury. These findings highlight the need for more research on those seeking specialized healthcare to improve clinical care and potentially prevent prolonged symptoms and problems.

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