Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms questionnaire.
Kirsch NL, de Leon MB, Maio RF, Millis SR, Tan-Schriner CU, Frederiksen S. Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms Questionnaire.


OBJECTIVE
To examine baseline variables and identify characteristics of participants with extremely high reports of symptoms (ie, outliers) 12 months after mild head injury (MHI).


METHODS
A prospective cohort study of MHI with and without loss of consciousness (LOC) and/or posttraumatic amnesia (PTA) recruited from and interviewed at the emergency department (ED), with a follow-up telephone interview at 12 months.


METHODS
Level II community hospital ED.


METHODS
Participants (n=58) with MHI and LOC less than or equal to 30 minutes and/or PTA less than 24 hours and participants (n=173) with MHI but no PTA/LOC.


METHODS
age greater than or equal to 18 years, less than or equal to 24 hours after injury, Glasgow Coma Scale score greater than or equal to 13, and discharge from the ED. Fourteen (6%) participants had extremely high scores on the Rivermead Postconcussion Symptoms Questionnaire (RPQ).


METHODS
RPQ and questions on health services use and litigation.


RESULTS
Characterizing the outlier cases are prior head injury, preinjury disability, history of substance use, unemployment, and elevated somatic symptoms at the ED. At 12 months, outliers had higher use of health services and litigation.


CONCLUSIONS
The existence of a subgroup with a distinctive pattern of baseline characteristics in combination with elevated somatic symptoms at the time of presentation to the ED suggests that further taxonomic distinctions may be warranted for the MHI population, each requiring appropriately targeted interventions for addressing symptomatic complaints.
Kirsch
Ned L
NL
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA. nlkirsch@umich.edu
de Leon
Marita B
MB
Maio
Ronald F
RF
Millis
Scott R
SR
Tan-Schriner
Cheribeth U
CU
Frederiksen
Shirley
S
D006259:Craniocerebral Trauma / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*; D004185:Disability Evaluation; D015600:Glasgow Coma Scale; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires