title: Postconcussional disorder: Are the DSM-IV criteria an improvement over the ICD-10?
abstract: Little is known about the characteristics and outcomes of patients diagnosed with postconcussional disorder (PCD) under the provisionally proposed criteria in the DSM-IV and how they differ from patients diagnosed with postconcussional syndrome (PCS) under the International Classification of Diseases, 10th edition clinical (ICD-10) criteria. This study investigated differences in outcome based on a diagnosis of PCD (DSM-IV) versus PCS (ICD-10 clinical criteria) as to which criteria set might be preferred for clinical practice. A consecutive series of adult patients with mild (N = 319) to moderate (N = 21) traumatic brain injury was assessed at 3 months postinjury with a brief neuropsychological battery and measures of specific outcome domains. In two separate series of analyses, patients with PCD were compared with those without PCD, and those with PCS were compared with those without PCS. Although the two criteria sets resulted in markedly different incidence rates, there was no substantial pattern of differences between the DSM-IV and ICD-10 in the outcome domains of psychiatric symptoms and disorders, social and community integration, health-related quality of life, or global outcome as measured by the Glasgow Outcome Scale-Extended. In spite of significant differences between the two diagnostic criteria sets and different incidence rates for PCD/PCS, outcome in all measured domains was very similar at 3 months postinjury. There is no compelling evidence, based on these outcome domains, to suggest which of the two diagnostic criteria sets should be clinically preferred.
authors.affiliation: Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: McCauley
authors.forename: Corwin
authors.initials: C
authors.lastname: Boake
authors.forename: Claudia
authors.initials: C
authors.lastname: Pedroza
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Brown
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Levin
authors.forename: Heather S
authors.initials: HS
authors.lastname: Goodman
authors.forename: Shirley G
authors.initials: SG
authors.lastname: Merritt
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001930:Brain Injuries / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D008297:Male; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D038223:Post-Concussion Syndrome / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D015599:Trauma Severity Indices