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Do Mild Traumatic Brain Injury Severity Sub-classification Systems Help to Identify People Who Go on to Experience Long-Term Symptoms?

Published online by Cambridge University Press:  06 July 2017

Alice Theadom ,
Suzanne Barker-Collo ,
Andrea Greenwood ,
Priya Parmar ,
Kelly Jones ,
Nicola Starkey ,
Kathryn McPherson  and
Valery L. Feigin
Alice Theadom*
Affiliation:
National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
Suzanne Barker-Collo
Affiliation:
School of Psychology, University of Auckland, Auckland, New Zealand
Andrea Greenwood
Affiliation:
School of Psychology, University of Auckland, Auckland, New Zealand
Priya Parmar
Affiliation:
National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
Kelly Jones
Affiliation:
National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
Nicola Starkey
Affiliation:
School of Psychology, University of Waikato, Hamilton, New Zealand
Kathryn McPherson
Affiliation:
Health Research Council of New Zealand, Auckland, New Zealand
Valery L. Feigin
Affiliation:
National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
*
Address for correspondence: Alice Theadom, PhD, National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, AUT North Shore Campus, AR417, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland 1142, New Zealand. E-mail: [email protected]
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Abstract

Objective: To identify the systems available to sub-classify mild traumatic brain injury (TBI) and to determine their utility in predicting 1-year outcome.

Methods: A systematic review to identify mild-TBI sub-classification systems was conducted until March 2016. The identified systems were applied to a cohort of N = 290 adults who had experienced a mild-TBI, and who had been assessed for post-concussion symptoms 1-year post injury. ANOVAs and regression models were used to determine whether each sub-classification system could distinguish between outcomes and to explore their contribution to explaining variance in post-concussion symptoms 1-year post injury.

Results: Nineteen sub-classification systems for mild-TBI met the inclusion criteria for this review. The Saal (1991) classification system significantly differentiated the experience of post-concussion symptoms in our cohort 1-year post injury (F = 2.39, p = 0.05). However, the findings did not remain significant following correction for multiple comparisons and inclusion of socio-demographic and contextual factors in the regression model.

Conclusions: Current sub-classification systems fail to explain much of the variance in post-concussion symptoms 1 year following mild-TBI. Further research is needed to identify the factors (including socio-demographic and contextual factors) to determine, who may be at risk of developing persistent post-concussion symptoms.

Keywords

mild traumatic brain injuryconcussionclassificationpost-concussion symptomsadults
Type
Articles
Information
Brain Impairment , Volume 19 , Special Issue 2: Mild Traumatic Brain Injury , September 2018 , pp. 119 - 132
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2017 

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References

American Academy of Neurology (1997). Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology, 48 (3), 581–585.Google Scholar
Anderson, T., Heitger, M., & MacLeod, A. D. (2006). Concussion and mild head injury. Practical Neurology, 6 (6), 342–357.Google Scholar
Andrade, A. F., Paiva, W. S., Soares, M. S., De Amorim, R. L., Tavares, W. M., & Teixeira, M. J. (2011). Classification and management of mild head trauma. International Journal of General Medicine, 27 (4), 175–179.Google Scholar
Belanger, H. G., Vanderploeg, R. D., Curtiss, G., & Warden, D. L. (2007). Recent neuroimaging techniques in mild traumatic brain injury. The Journal of Neuropsychiatry and Clinical Neurosciences, 19 (1), 5–20.Google Scholar
Buck, P. W., Laster, R. G., Sagrati, J. S., & Kirzner, R. S. (2012). Working with mild traumatic brain injury: voices from the field. Rehabilitation Research and Practice, Feb 7, 1–6.Google Scholar
Cantu, R. C. (2001). Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36 (3), 244–248.Google Scholar
Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, Feb (Suppl. 43), 113–125.Google Scholar
Cassidy, J. D., Carroll, L. J., Peloso, P. M., Borg, J., von Holst, H., Holm, L., . . . Coronado, V. G. (2004). Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, Feb (Suppl. 43), 28–60.Google Scholar
Culotta, V., Sementilli, M. E., Gerold, K., & Watts, C. C. (1996). Clinicopathological heterogeneity in the classification of mild head injury. Neurosurgery, 38 (2), 245–250.Google Scholar
De Kruijk, J. R., Leffers, P., Menheere, P. P., Meerhoff, S., Rutten, J., & Twijnstra, A. (2002). Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. Journal of Neurology, Neurosurgery and Psychiatry, 73 (6), 727–732.Google Scholar
Feigin, V. F., Theadom, A., Barker-Collo, S. L., Starkey, N., McPherson, K., Kahan, M., . . . on behalf of the BIONIC Research Group. (2013). Incidence of traumatic brain injury in New Zealand: a population-based study. The Lancet Neurology, 12 (1), 53–64.Google Scholar
Galetta, K. M., Barrett, J., Allen, M., Madda, F., Delicata, D., Tennant, A. T., . . . Balcer, L. J. (2011). The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology, 76 (17), 1456–1462.Google Scholar
Guskiewicz, K. M. (2001). Concussion in sport: the grading-system dilemma. Athletic Therapy Today, 6 (1), 18–27.Google Scholar
Hawryluk, G. W. J., & Manley, G. T. (2015). Part 1. Classification of traumatic brain injury: past, present and future. Handbook of Clinical Neurology, In Grafman, J. & Salazar, A.M. Elsevier (Eds.), Vol. 127, pp. 15–21.Google Scholar
Hugenholtz, H., & Richard, M. T. (1982). Return to athletic competition following concussion. Canadian Medical Association Journal, 127 (9), 827–829.Google Scholar
Iverson, G. L. (2005). Outcome from mild traumatic brain injury. Current opinion in psychiatry, 18 (3), 301–317.Google Scholar
Iverson, G. L. (2010). Mild traumatic brain injury meta-analyses can obscure individual differences. Brain Injury, 24 (10), 1246–1255.Google Scholar
Jacobs, B., Beems, T., Stulemeijer, M., van Vugt, A. B., van der Vliet, T. M., Borm, G. F., & Vos, P. E. (2010). Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities. Journal of Neurotrauma, 27 (4), 655–668.Google Scholar
Jordan, B. J., & Tsairis, P. T. (1989). Sports neurology (Vol. 227). Gaithersburg, MD: Aspen Publishers.Google Scholar
Kelly, J. P., Nichols, J. S., Filley, C. M., Lillehei, K. O., Rubinstein, D., & Kleinschmidt-DeMasters, B. K. (1991). Concussion in sports: guidelines for the prevention of catastrphic outcome. Journal of the American Medical Association, 266 (20), 2867–2869.Google Scholar
King, N. S., Crawford, S., Wenden, F. J., Caldwell, F. E., & Wade, D. T. (1999). Early prediction of persisting post-concussion symptoms following mild and moderate head injuries. British Journal of Clinical Psychology, 38 (1), 15–25.Google Scholar
King, N. S., Crawford, S., Wenden, F. J., Moss, N. E., & Wade, D. T. (1995). The rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242 (9), 587–592.Google Scholar
Lannsjo, M., Geijerstam, J. L., Johansson, U., Bring, J., & Borg, J. (2009). Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort. Brain Injury, 23 (3), 213–219.Google Scholar
Leclerc, S., Lassonde, M., Delaney, S., Lacroix, V. J., & Johnston, K. M. (2001). Recommendations for the grading of concussion in athletes. Sports Medicine, 31 (8), 629–636.Google Scholar
Lingsma, H., Yue, J. K., Maas, A., Steyerberg, E. W., Manley, G. T. M. D. P. D., Cooper, S. R., . . . Yuh, E. L. (2015). Outcome prediction after mild and complicated mild traumatic brain injury: external validation of existing models and identification of new predictors using the TRACK-TBI pilot study. Journal of Neurotrauma, 32 (2), 83–94.Google Scholar
Malec, J. F., Brown, A. W., Leibson, C. L., Flaada, J. T., Mandrekar, J. N., Diehl, N. N., & Perkins, P. K. (2007). The mayo classification system for traumatic brain injury severity. Journal of Neurotrauma, 24 (9), 1417–1424.Google Scholar
Maroon, J. C., Steele, P. B., & Berlin, R. (1980). Football head and neck injuries – an update. Clinical Neurosurgery, 27, 414–429.Google Scholar
Marosszeky, N. E. V., Ryan, L., Shores, E. A., Batchelor, J., & Marosszeky, J. E. (1997). The PTA Protocol: Guidelines for using the Westmead Post-Traumatic Amnesia (PTA) Scale. Sydney: Wild & Wooley.Google Scholar
Marshall, S., Bayley, M., McCullagh, S., Velikonja, D., Berrigan, L., Ouchterlony, D., . . . on behalf of the mTBI Expert Consensus Group. (2015). Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Injury, 29 (6), 688–700.Google Scholar
McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R. J., . . . Turner, M. (2013). Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. British Journal of Sports Medicine, 47 (5), 259–262.Google Scholar
McMahon, P., Hricik, A., Yue, J. K., Puccio, A. M., Inoue, T., Lingsma, H. F., . . . Vassar, M. J. (2014). Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective track-TBI study. Journal of Neurotrauma, 31 (1), 26–33.Google Scholar
Menon, D. K., Schwab, K., Wright, D. W., Maas, A. I., & The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. (2010). Position statement: definition of traumatic brain injury. Archives of Physical Medicine & Rehabilitation, 91 (11), 1637–1640.Google Scholar
Morris, P. G., Prior, L., Shoumitro, D., Lewis, G., Mayle, W., Burrow, C. E., & Bryant, E. (2005). Patients' views on outcome following head injury: a qualitative study. BMC Family Practice, 6 (30).Google Scholar
Nelson, W. E., Jane, J. A., & Gieck, J. H. (1984). Minor head injury in sports: a new system of classification and management. Physician Sports Medicine, 12 (3), 103–107.Google Scholar
Ommaya, A. K. (1985). Biomechanis of head injury: experimental aspects. In Nahum, A.M. & Melvin, J. (Eds.), The biomechanics of trauma (pp. 245–269). Norwalk, Conneticut: Appleton-Century-Crofts.Google Scholar
Rapp, P. E., & Curley, K. C. (2012). Is a diagnosis of “mild traumatic brain injury” a category mistake?. Journal of Trauma and Acute Care Surgery, 73 (2 Suppl. 1), S13–23. doi:10.1097/TA.0b013e318260604bGoogle Scholar
Roberts, W. (1992). Who plays? Who sits? Managing concussions in sport. Physician Sports Medicine, 20 (6), 66–72.Google Scholar
Røe, C., Sveen, U., Alvsåker, K., & Bautz-Holter, E. (2009). Post-concussion symptoms after mild traumatic brain injury: influence of demographic factors and injury severity in a 1-year cohort study. Disability and Rehabilitation, 31 (15), 1235– 1243.Google Scholar
Ruff, R. M., & Jurica, P. (1999). In search of a unified definition for mild traumatic brain injury. Brain Injury, 13 (12), 943–952.Google Scholar
Saal, J. A. (1991). Common American football injuries. Sports Medicine, 12 (2), 132–147.Google Scholar
Saban, K. L., Hogan, N. S., Hogan, T. P., & Pape, T. L. (2015). He looks normal but . . . challenges of family caregivers of veterans diagnosed with a traumatic brain injury. Rehabilitation Nursing, 40 (5), 277–285.Google Scholar
Scheenen, M. E. Spikman, J. M., de Koning, M. E., van der Horn, J. J., Roks, G., Hageman, G., & van der Naalt, J. (2017). Patients “At Risk” of suffering from persistent complaints after mild traumatic brain injury: the role of coping, mood disorders, and post-traumatic stress. Neurotrauma, 34 (1), 31–37.Google Scholar
Schneider, R. C., & Kriss, F. C. (1973). First aid and diganosis – the treatment of head injuries. In Schneider, R.C. (Ed.), Head and neck injuries in football: mechanisms, treatment and prevention (pp. 163–187). Baltimore, MA: Williams and Wilkins Co.Google Scholar
Servadei, F., Teasdale, G., & Merry, G. (2001). Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis and management. Journal of Neurotrauma, 18 (7), 657–664.Google Scholar
Stein, S. C., & Spettell, C. (1995). The Head Injury Severity Scale (HISS): a practical classification of closed-head injury. Brain Injury, 9 (5), 437–444.Google Scholar
Studerus-Germann, A. M., Thiran, J. P., Daducci, A., & Gautschi, O. P. (2016). Diagnostic approaches to predict persistent post-traumatic symptoms after mild traumatic brain injury – a literature review. International Journal of Neuroscience, 126 (4), 289–298.Google Scholar
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2 (7872), 81–84.Google Scholar
Tellier, A., Della Malva, L. C., Cwinn, A., Grahovac, S., Morrish, W., & Brennan-Barnes, M. (1991). Mild head injury: a misnomer. Brain Injury, 13 (7), 463–475.Google Scholar
Theadom, A., Barker-Collo, S., Feigin, V., Starkey, N., Jones, K., Jones, A., . . . on behalf of the BIONIC Research Group. (2012). The spectrum captured: a methodological approach to studying incidence and outcomes of traumatic brain injury on a population level. Neuroepidemiology, 38 (1), 18–29.Google Scholar
Theadom, A., Parag, V., Dowell, T., McPherson, K., Starkey, N., Barker-Collo, S., . . . Group, B. R. (2016). Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. British Journal of General Practice, 66 (642), e16–23.Google Scholar
Torg, J. S. (1991). Athletic injuries to the head, neck and face. St Louis, MO: Mosby Year Book: 226.Google Scholar
Vos, P. E., Battistin, L., Birbamer, G., Gerstenbrand, F., Potapov, A., Prevec, T., . . . von Wild, K. (2002). EFNS guideline on mild traumatic brain injury: report of an EFNS task force. European Journal of Neurology, 9 (3), 207–219.Google Scholar
Wilberger, J. E., & Maroon, J. C. (1989). Head injuries in athletes. Clinics in Sports Medicine, 8 (1), 1–9.Google Scholar
Zumstein, M. A., Moser, M., Mottini, M., Ott, S. R., Sadowski-Cron, C., Radanov, B. P., . . . Exadaktylos, A. (2011). Long-term outcome in patients with mild traumatic brain injury: a prospective observational study. Journal of Trauma, 7 (1), 120–127.Google Scholar