Risk Factors ID’d for Persistent Concussion Symptoms

TOPLINE:

Concentration difficulties, a medical history of anxiety and/or depression or sleep disorders, and clinical signs such as loss of consciousness and amnesia were all associated with an increased risk for persisting symptoms after concussion (PSAC) in adults with mild traumatic brain injury (TBI), a new meta-analysis showed.

METHODOLOGY: 

• The meta-analysis included 15 studies published from 1970 to February 15, 2024.
• Data for more than 592,000 adults (mean age, 29.3 years; 58% men) with mild TBI but no intracranial abnormalities were included.
• Primary outcomes included PSAC at 1, 3, and 6 months after concussion, and combined and classified as “across all timepoints.”

TAKEAWAY:

• Among all factors, acute difficulty in concentration showed the strongest association with increased PSAC risk at 1 month (adjusted odds ratio [aOR], 3.1) and 6 months (aOR, 26.8) post-concussion, and across all timepoints (aOR, 3.4).
• A medical history of anxiety and/or depression or of sleep disorders was significantly associated with an increased risk for PSAC at 1 month (aOR, 2.6), at 3 months (aOR, 2.9), and across all timepoints (aOR, 2.5).
• The clinical signs of loss of consciousness and amnesia were significantly linked to increased PSAC risk at all time points (aOR, 1.9), while being a woman was linked to increased risk at 3 months and at all time points (aORs, 2.1 and 1.70, respectively).
• Mechanism of injury, specifically motor vehicle collision, was associated with increased odds for PSAC at 1 month (aOR, 2.0).

IN PRACTICE:

The findings suggest that the existence of specific acute symptoms after concussion “may be more important to evaluate than the sheer number of symptoms when evaluating concussion prognosis,” the investigators wrote. 

“Future longitudinal studies should consider evaluating acute risk factors of PSAC at different time points after concussion in addition to evaluating how risk factors may be combined to create a multivariable prediction model,” they added.

SOURCE:

The study was led by Samantha J. McIntosh, Cumming School of Medicine, University of Calgary, Calgary, Canada. It was published online on June 18 in JAMA Network Open.

LIMITATIONS: 

Key limitations included high between-study heterogeneity driven by inconsistent PSAC definitions and diverse recruitment settings, including emergency departments, military, sports, and clinics. Additionally, inconsistent age reporting across studies prevented clear age-related risk estimates, and restricting the sample to adults without intracranial abnormalities limited the generalizability of the findings.

DISCLOSURES:

Two of the investigators reported receiving grants from the Canadian Institutes of Health Research, with one also reporting receiving grants from the Hotchkiss Brain Institute. The other investigators reported no relevant financial disclosures. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.