Knowledge of post-concussional syndrome in naive lay-people, general practitioners and people with minor traumatic brain injury

Background. Expectations about effects of minor traumatic brain injury (MTBI) may play a role in maintaining symptoms, the ability to simulate post-concussion syndrome (PCS) and the extent to which professionals might associate patient complaints with MTBI. In turn, expectations will be related to knowledge about MTBI. This study investigates knowledge of PCS in people with MTBI compared with general practitioners (GPs) and lay-people, using recall (a vignette) and symptom guessing or recognition (checklists). Methods. Thirty GPs, 30 people with MTBI, and 30 lay-people generated symptoms from a vignette describing a MTB1. They then completed a PCS checklist or a checklist containing PCS and 'bogus' items pertaining to the vignette. Results. Only 1 of 90 participants reported enough PCS symptoms to indicate 'caseness' from the vignette alone. Using checklists, more GPs (60%) than controls (20%) ticked enough symptoms to attain PCS'caseness'. Few people with MTB1 who did not themselves achieve PCS 'caseness' by self-report using checklists achieved Icaseness' using the vignette and checklists. The frequency of non-physical symptom reporting was higher than for physical symptom reporting. The addition of 'bogus' items to checklists did not affect responding. Conclusions. It is unlikely that pre-injury expectations about MTBI maintain PCS symptoms. PCS was difficult to simulate without prompting, even by GPs and PCS,cases'. The use of 'caseness', rather than simple symptom scores, and further development of checklists with 'bogus' items may provide a more valid assessment of MTBI effects. GPs may benefit from further information about PCS and available treatments.