Research Reports - Postconcussion syndrome: demographics and predictors in 221 patients

J Neurosurg. 2016 Feb 26:1-11. [Epub ahead of print]

Tator CH(1,)(2), Davis HS(1), Dufort PA(1), Tartaglia MC(1,)(3), Davis
KD(1,)(2,)(3), Ebraheem A(1), Hiploylee C(1).

OBJECTIVE The objective of this study was to determine the demographics and
predictors of postconcussion syndrome (PCS) in a large series of patients using a
novel definition of PCS. METHODS The authors conducted a retrospective cohort
study of 284 consecutive concussed patients, 221 of whom had PCS on the basis of
at least 3 symptoms persisting at least 1 month. This definition of PCS was
uniformly employed and is unique in accepting an expanded list of symptoms, in
shortening the postconcussion interval to 1 month from 3 months, and in excluding
those with focal injuries such as hemorrhages and contusions. RESULTS The 221
cases showed considerable heterogeneity in clinical features of PCS. They
averaged 3.3 concussions, with a range of 0 to 12 or more concussions, and 62.4%
occurred during sports and recreation. The median duration of PCS was 7 months at
the time of examination, with 11.8% lasting more than 2 years, and 23.1% with PCS
had only 1 concussion. The average patient age was 27 years (range 10-74 years).
The average number of persistent symptoms was 8.1; 26.2% had a previous
psychiatric condition, attention-deficit disorder/attention-deficit hyperactivity
disorder, a learning disability, or previous migraine headaches. The prevalence
of arachnoid cysts and Chiari malformation in PCS exceeded the general
population. Additionally, involvement in litigation, presence of extracranial
injuries, amnesia and/or loss of consciousness, and female sex were predictive of
reporting a high number of symptoms. A prior history of psychiatric conditions or
migraines, cause of injury, number of previous concussions, and age did not
significantly predict symptom number. Only the number of symptoms reported
predicted the duration of PCS. To predict the number of symptoms for those who
fulfilled PCS criteria according to the International Classification of Diseases,
10th Revision (ICD-10), and the Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition (DSM-IV), the number of previous concussions was
significant. CONCLUSIONS PCS is commonly associated with multiple concussions,
but 23.1% in the present series occurred after only 1 concussion. Most patients
with PCS had multiple symptoms persisting for months or years. The median
duration of PCS was 7 months, with a range up to 26 years. In only 11.3%, the PCS
had ended at the time of consultation. Not all predictors commonly cited in the
literature align with the findings in this study. This is likely due to
differences in the definitions of PCS used in research. These results suggest
that the use of ICD-10 and DSM-IV to diagnose PCS may be biased toward those who
are vulnerable to concussions or with more severe forms of PCS. It is thus
important to redefine PCS based on evidence-based medicine.

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