Predicting mild traumatic brain injury patients at risk of persistent symptoms in the Emergency Department
1Department of Emergency Medicine, Upstate Medical University , Syracuse, NY , USA.
Objective:
To identify factors that can predict which emergency department (ED) patients with mTBI are likely to develop persistent post-concussion symptoms (PPCS).
Design:
A matched case-control study was conducted at a Level 1 trauma centre between June 2006 and July 2009. Patients diagnosed with mTBI in the ED and diagnosed at a concussion management programme with at least one PPCS (85 cases) were compared to patients diagnosed with mTBI in the ED (340 controls) to determine if factors assessed at the time of ED presentation could predict patients likely to develop persistent symptoms.
Results:
Multivariable hierarchical logistic regression with variables indicating increased risk for PPCS (prior mTBI, history of depression, history of anxiety, multiple injury, forgetfulness/poor memory, noise sensitivity, or light sensitivity) resulted in a final predictive model including prior mTBI, history of anxiety, forgetfulness/poor memory and light sensitivity. The final model had a specificity of 87.9% and a sensitivity of 69.9%.
Conclusions:
A strong prediction model to identify those ED patients with mTBI at risk for PPCS was developed and could be easily implemented in the ED; therefore, helping to target those patients who would potentially benefit from close follow-up.
Insights
A predictive model can identify emergency department patients with mild traumatic brain injury (mTBI) at risk for persistent post-concussion symptoms (PPCS). Key predictors include prior mTBI, anxiety history, memory issues, and light sensitivity.
Area of Science:
- Neurology
- Emergency Medicine
- Trauma Care
Background:
- Mild traumatic brain injury (mTBI) is a common emergency department (ED) presentation.
- A significant subset of mTBI patients develop persistent post-concussion symptoms (PPCS).
- Predicting PPCS risk in the ED is crucial for targeted patient management.
Purpose of the Study:
- To identify predictive factors for PPCS in ED patients with mTBI.
- To develop a model for early identification of at-risk individuals.
- To facilitate timely intervention for patients likely to experience prolonged symptoms.
Main Methods:
- A matched case-control study was conducted at a Level 1 trauma center.
- 85 cases with mTBI and PPCS were compared to 340 mTBI controls.
- Predictive factors were assessed at the time of ED presentation.
Main Results:
- Multivariable logistic regression identified key predictors for PPCS.
- Significant predictors included prior mTBI, history of anxiety, forgetfulness/poor memory, and light sensitivity.
- The final model achieved 87.9% specificity and 69.9% sensitivity.
Conclusions:
- A robust predictive model for identifying ED patients with mTBI at risk of PPCS was developed.
- This model can be readily implemented in the ED setting.
- Early identification enables targeted follow-up for patients who may benefit most.
