Early prediction of persisting post-concussion symptoms following mild and moderate head injuries

Objectives. King (1996) reported that a combination of emotional, organic and neuropsychological measures taken at 7‐10 days following mild and moderate head injury may significantly help predict patients most likely to suffer persisting postconcussion symptoms (PCS) at three months post‐injury. This study investigated a cross‐validation sample (N= 57) to determine whether the results would be replicated for the early prediction of longer‐term sufferers (i.e. those with persisting symptoms at 6 months post‐injury). Design. Multiple regression analyses were used in which scores on the Hospital Anxiety and Depression Scale, Impact of Event Scale, Short Orientation Memory and Concentration Test, Rivermead Post‐Concussion Symptoms Questionnaire and Post‐Traumatic Amnesia taken at 7‐10 days post‐injury were the independent measures. Scoring on the Rivermead Post‐Concussion Symptoms Questionnaire taken at 6 months post‐injury was the dependent measure. Methods. Sixty‐six consecutive patients admitted to any trauma ward in Oxfordshire with a mild or moderate head injury were recruited from a largescale randomized controlled sample. The assessment measures were administered at 7‐10 days post‐injury and the Rivermead Post‐Concussion Symptoms Questionnaire at 6 months post‐injury. Nine patients were unable to be followed up, leaving an active sample of 57. Results. The cross‐validation data confirmed that a similar combination of measures to that found in the original study best predicted persisting PCS but that the strength of prediction diminished for the longer term prediction (i.e. 6 months post‐injury). Conclusions. The Hospital Anxiety and Depression Scale, Impact of Event Scale and Post‐Traumatic Amnesia in combination are recommended as useful prognostic screening instruments for predicting persisting PCS, but great caution is required if they are used to aid predictions beyond 3 months post‐injury.