Use of In-Hospital Mild Traumatic Brain Injury Symptom Checklist Within 24 Hours of Injury to Predict 3-Month Symptom Outcome.

BACKGROUND

Experts recommend administering a traumatic brain injury (TBI) symptom checklist as part of routine evaluation for TBI with Glasgow Coma Scale score 13-15 ("mild" TBI [mTBI]) in adult emergency departments (EDs). However, such assessment is not routine, partly due to limited guidance on interpreting symptom scores.

OBJECTIVES

Assess the utility of Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores, assessed in-hospital within 24 h of injury (day 1), in discriminating individuals with, vs. without, persistent TBI-related symptoms (persistent post-concussive symptoms [PPCS]) at 3 months post-injury, and provide interpretive guidance.

METHODS

Adults with mTBI across three Level I trauma centers completed the RPQ at day 1 and 3 months post-injury. Using binary logistic regression models and fivefold internal cross-validation, we calculated the mean area under the curve (AUC) for day 1 RPQ total score in predicting 3-month PPCS. Clinical interpretation tables were provided.

RESULTS

Two hundred fifty-two participants who completed a day 1 RPQ were included in the analysis. Inverse probability weighting was used to adjust for bias in attrition (n = 168 followed). The mean cross-validated AUC was 0.84 using day 1 RPQ score alone. Multivariable models, including those using previously validated sets of variables, did not outperform day 1 RPQ alone.

CONCLUSIONS

In adults presenting to Level I trauma centers for acute mTBI, symptom burden (RPQ total score) is robustly associated with 3-month symptom outcome. The RPQ, which can be completed in about 3 min, may support recognition of mTBI symptoms in the ED and risk stratification for triage into appropriate follow-up pathways.