Long-Term Outcomes of Patients Seeking Specialized Health Care for Persisting Postconcussion Symptoms After a Mild Head Injury.

OBJECTIVE

To examine long-term outcomes of persisting postconcussion symptoms (PPCS) after mild head injury in patients seeking specialist care.

DESIGN

Longitudinal cohort study. Baseline interview at outpatient admission and follow-up interviews at 3, 6, 12, 18, 24, 30, 36, 48, and 60 months postinjury, and 5 years after outpatient admission.

SETTING

Rehabilitation clinic.

PARTICIPANTS

Patients (N=191) with PPCS after mild head injury over the past 5 years.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Symptoms assessed by Rivermead Postconcussion Symptoms Questionnaire, functioning via Glasgow Outcome Scale-Extended and return to full-time work. Linear and logistic mixed models with and without interaction terms evaluated outcomes over time, while within-subject change was assessed from participants' first to last assessments.

RESULTS

The sample comprised 800 assessments (mean 4.2 [SD, 1.7] per participant). Patients were divided into groups by time from injury to outpatient admission (group 1: 0-3mo [n=44]; group 2: 3-6mo [n=54]; group 3: 6-12mo [n=47]; group 4: 12-24mo [n=26]; group 5: 24-60mo [n=20]). Although the groups had similar clinical characteristics at outpatient admission, their outcomes over time differed. Substantial symptom reduction and functional improvement were observed over time in groups 1-4, but not in group 5. Most symptom relief across groups occurred in the months after outpatient admission.

CONCLUSIONS

In patients seeking care for PPCS, most exhibited improvement over time and worsening was rare. However, many still experienced symptoms years after outpatient admission, and outpatient admission ≥2 years postinjury was associated with significantly poorer outcomes.