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Persistent Postconcussion Symptoms: An Expert Consensus-Based Definition Using the Delphi Method
Corinne Lagacé-Legendre1, Valérie Boucher, Sébastien Robert
1Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec (Dr Lagacé-Legendre, Ouellet, Émond, Moore, and Le Sage, Ms Boucher, and Mr Tardif), and Faculté de médecine (Drs Lagacé-Legendre, Robert, Ouellet, Frémont, Émond, Moore, and Le Sage and Ms Boucher), Université Laval, Quebec City, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec City, Quebec, Canada (Ms Boucher and Drs Ouellet, Émond, and Le Sage); Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec City, Quebec, Canada (Dr Ouellet); Research-Institute, McGill University Health Centre, Montreal, Quebec, Canada (Dr de Guise); Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada (Dr de Guise); and La Clinique Neuropsychologique, Québec, Canada (Dr Boulard).
Objective:
To provide an expert consensus definition of persistent postconcussion symptoms following a mild traumatic brain injury (mTBI).
Participants:
Canadian healthcare professionals caring for patients with mTBI.
Design:
Online Delphi process.
Main Measures:
A first Delphi round documented important dimensions or criteria to consider when defining persistent symptoms. Expert opinions were then resubmitted in 4 subsequent Delphi rounds and their relevance was rated using a 9-point Likert scale. An item with a median rating of 7 or more and a sufficient level of agreement were considered consensual.
Results:
After 5 rounds, consensus was reached on a set of criteria that can be summarized as follows: presence of any symptom that cannot be attributed to a preexisting condition and that appeared within hours of an mTBI, that is still present every day 3 months after the trauma, and that has an impact on at least one sphere of a person's life.
Conclusion:
This Delphi consensus proposes a set of criteria that support a more uniform definition of persistent symptoms in mild TBI among clinicians and researchers. This definition may help clinicians better identify persistent postconcussion symptoms and improve patient management.
