Research Reports - Patients "At Risk" of Suffering from persistent complaints after mild traumatic brain injury: The role of coping, mood disorders, and post-traumatic stress

J Neurotrauma. 2016 Aug 25. [Epub ahead of print]

Scheenen ME(1), Spikman JM(1), de Koning ME(2), van der Horn HJ(2), Roks G(3),
Hageman G(4), van der Naalt J(2).

Although most patients recover fully following mild traumatic brain injury
(mTBI), a minority (15-25%) of all patients develop persistent post-traumatic
complaints (PTC) that interfere with the resumption of previous activities. An
early identification of patients who are at risk for PTC is currently performed
by measuring the number of complaints in the acute phase. However, only part of
this group will actually develop persisting complaints, stressing the need for
studies on additional risk factors. This study aimed to compare this group of
patients with many complaints with patients with few and no complaints to
identify potential additional discriminating characteristics and to evaluate
which of these factors have the most predictive value for being at risk. We
evaluated coping style, presence of psychiatric history, injury characteristics,
mood-related symptoms, and post-traumatic stress. We included 820 patients
(Glasgow Coma Scale [GCS] score 13-15) admitted to three level-1 trauma centers
as part of the UPFRONT-study. At 2 weeks after injury, 60% reported three or more
complaints (PTC-high), 25% reported few complaints (PTC-low), and 15% reported no
complaints (PTC-zero). Results showed that PTC-high consisted of more females
(78% vs. 73% and 52%, p < 0.001), were more likely to have a psychiatric history
(7% vs. 2% and 5%), and had a higher number of reported depression (22% vs. 6%
and 3%, p < 0.001), anxiety (25% vs. 7% and 5%), and post-traumatic stress (37%
vs. 27% and 19%, p < 0.001) than the PTC-low and PTC-zero groups. We conclude
that in addition to reported complaints, psychological factors such as coping
style, depression, anxiety, and post-traumatic stress symptoms had the highest
predictive value and should be taken into account in the identification of
at-risk patients for future treatment studies. 

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