4.5 Article

Post-Concussion Symptoms Rule: Derivation and Validation of a Clinical Decision Rule for Early Prediction of Persistent Symptoms after a Mild Traumatic Brain Injury

Journal

JOURNAL OF NEUROTRAUMA
Volume 39, Issue 19-20, Pages 1349-1362

Publisher

MARY ANN LIEBERT, INC
DOI: 10.1089/neu.2022.0026

Keywords

clinical decision rule; concussion; mild traumatic brain injury (mTBI); persistent post-concussion symptoms; screening tool

Funding

  1. Canadian Institute of Health Research [127055, 366162]
  2. Fondation du CHU de Quebec Universite Laval [3062]

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This study aimed to develop and validate a clinical decision rule (CDR) for the early prediction of persistent post-concussion symptoms (PPCS) in patients with mild traumatic brain injury (mTBI). The study found that the derived rule, called the Post-Concussion Symptoms Rule (PoCS Rule), could effectively stratify the risk of PPCS and assist emergency physicians in planning post-discharge resources.
Mild traumatic brain injury (mTBI) is a common problem. Depending on diagnostic criteria, 13 to 62% of those patients develop persistent post-concussion symptoms (PPCS). The main objective of this prospective multi-center study is to derive and validate a clinical decision rule (CDR) for the early prediction of PPCS. Patients aged >= 14 years were included if they presented to one of our seven participating emergency departments (EDs) within 24 h of an mTBI. Clinical data were collected in the ED, and symptom evolution was assessed at 7, 30 and 90 days post-injury using the Rivermead Post-Concussion Questionnaire (RPQ). The primary outcome was PPCS at 90 days after mTBI. A predictive model called the Post-Concussion Symptoms Rule (PoCS Rule) was developed using the methodological standards for CDR. Of the 1083 analyzed patients (471 and 612 for the derivation and validation cohorts, respectively), 15.6% had PPCS. The final model included the following factors assessed in the ED: age, sex, history of prior TBI or mental health disorder, headache in ED, cervical sprain and hemorrhage on computed tomography. The 7-day follow-up identified additional risk factors: headaches, sleep disturbance, fatigue, sensitivity to light, and RPQ >= 21. The PoCS Rule had a sensitivity of 91.4% and 89.6%, a specificity of 53.8% and 44.7% and a negative predictive value of 97.2% and 95.8% in the derivation and validation cohorts, respectively. The PoCS Rule will help emergency physicians quickly stratify the risk of PPCS in mTBI patients and better plan post-discharge resources.

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