Comparing PROMIS Global Health and Rivermead Post-concussion Symptoms Questionnaire in adult traumatic brain injury

Patient-reported outcomes are essential for monitoring recovery after traumatic brain injury (TBI), yet commonly used instruments differ in scope. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is symptom-specific, whereas Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health is a generic measure of physical and mental health. The degree to which these tools provide overlapping versus non-interchangeable information in outpatient TBI care is unclear.

We conducted a retrospective observational study at a Level I academic trauma center (June 2018-February 2025). Adults (≥18 years) evaluated for TBI who completed paired RPQ and PROMIS Global Health assessments within ±3 days were included (one paired assessment per patient). Clinical and injury variables were abstracted from the electronic medical record and REDCap; head CT was classified as positive versus negative based on neuroradiology report, and polytrauma was defined as non-neurosurgical injuries requiring additional service management. Associations between PROMIS domains (physical, mental, total; higher scores indicating better health) and RPQ burden (RPQ-3, RPQ-13, total; higher scores indicating greater symptom burden) were assessed using Spearman correlation. Agreement was evaluated using two-way random-effects intraclass correlation coefficients (ICC; absolute agreement), Bland-Altman analysis after linear transformation to a 0-100 scale with standardized directionality, and kappa for selected construct-matched item pairs.

Of 372 screened patients, 216 met inclusion criteria. Median age was 58 years (IQR 39-73); 67% were male; 84% had mild TBI by admission Glasgow Coma Scale; 51% had polytrauma. PROMIS domains showed consistent inverse correlations with RPQ burden (ρ -0.41 to -0.68; all p < 0.001), strongest for PROMIS total versus RPQ-13 (ρ = -0.68) and RPQ total (ρ = -0.67). Despite these associations, patient-level agreement was poor: ICCs were negative across PROMIS-RPQ pairings (ICC -0.04 to -0.49) and Bland-Altman limits of agreement were wide. Construct-matched item agreement was moderate to substantial (κ 0.46-0.64), highest for combined affect ("angry and sad") (κ = 0.64).

PROMIS and RPQ are associated at the group level but demonstrate poor agreement and should not be used interchangeably for individual outpatient TBI monitoring. Findings support combined use of global and symptom-specific instruments across care settings.