Factors Associated With Persistent Symptoms Following Mild Traumatic Brain Injury

Traumatic brain injury (TBI) is a common presentation in which it is clinically difficult at presentation to identify patients at risk for persistent symptoms, defined as lasting longer than 30 days. Few studies report the time period from injury to presentation; thus, it may be useful to determine early findings that identify patients who are likely to have persistent 30-day symptoms.

To identify parameters associated with persistent 30-day symptoms in adult emergency department (ED) patients presenting shortly after a mild TBI (mTBI).

This cohort analysis used the large and still enrolling HeadSMART II (Head Injury Serum Markers and Multi-modalities for Assessing Response to Trauma II) dataset. HeadSMART II began enrollment in 2021, and all patients with mTBI enrolled as of July 1, 2024, were included in this analysis.

A diagnosis of mTBI, defined as a Glasgow Coma Scale score of 13 or higher.

The primary outcome was mTBI symptoms persisting 30 days after presentation. The 30-day Rivermead Post Concussion Symptoms Questionnaire was used to define persistent symptoms. Wilcoxon rank-sum testing was applied to continuous variables, and the Fisher exact test was applied to categorical variables.

Overall, 803 HeadSMART II patients (median [IQR] age, 41.0 [27.0-57.0] years; 404 male [50.3%]) with 30-day follow-up data were assessed at a median (IQR) of 1.5 (0.7-10.6) hours after their injury. Most patients were employed (565 of 794 patients [71.2%]) and had a fall or head struck by object as the mechanism of injury (387 of 802 patients [48.3%]). Trauma above clavicle (279 of 404 men [69.1%] vs 231 of 398 women [58.0%]) and the presence of fracture (103 of 403 men [25.6%] vs 60 of 396 women [15.2%]) or laceration (156 of 404 men [38.6%] vs 94 of 398 women [23.6%]) occurred more often in men than in women, whereas headaches occurred more often in women than in men (338 of 398 women [84.9%] vs 314 of 401 men [78.3%]). Over time, TBI symptoms declined for all. The presentation characteristics associated with persistent 30-day symptoms included female sex (odds ratio [OR], 2.09; 95% CI, 1.54-2.87); elevated body mass index (ie, 32.6; OR, 1.03; 95% CI, 1.01-1.06); mechanism of injury, including fall (OR, 2.87; 95% CI, 1.28-7.67), vehicular crash (OR, 3.79; 95% CI, 1.68-10.19), and abuse (OR, 3.67; 95% CI, 1.43-10.73); a prior diagnosis of headaches or migraines (OR, 2.76; 95% CI, 1.94-3.92), depression (OR, 2.25; 95% CI, 1.64-3.10), or anxiety (OR, 2.52; 95% CI, 1.83-3.48); and the presence of focal neurological deficits (OR, 1.52; 95% CI, 1.10-2.10), headache (OR, 2.08; 95% CI, 1.35-3.32), or multiple computed tomography scans (OR, 2.22; 95% CI, 1.49-3.36) at intake.

In the 803 patients with mTBI with complete 30-day data and a median initial presentation of 90 minutes after injury, those with any of the 9 identified baseline characteristics were more likely than patients without those characteristics to have persistent postconcussive symptoms at 30 days.