EMOTIONAL, NEUROPSYCHOLOGICAL, AND ORGANIC FACTORS - THEIR USE IN THEPREDICTION OF PERSISTING POSTCONCUSSION SYMPTOMS AFTER MODERATE AND MILD HEAD-INJURIES

Background-After mild and moderate bead injuries a range of postconcus sion symptoms (PCS) are often reported by patients. Both organic and p sychogenic factors can contribute to these. Full recovery from PCS usu ally occurs within three months of the injury. A significant minority, however, continue to experience symptoms beyond this time. To date, n o means of identifying these patients early after injury has been repo rted. This study investigates whether a combination of neuropsychologi cal, emotional, and traditional measures of severity of head injury ta ken early after the injury can help predict severity of FCS three mont hs after injury. Methods-50 patients with mild or moderate head injury had a range of measures administered at 7-10 days after injury. These included three tests of divided attention, a PCS rating scale-the Riv ermead postconcussion symptoms questionnaire (RPQ), the hospital anxie ty and depression scale (BADS), the impact of event scale (IES), and p ost-traumatic amnesia. An RPQ was then completed by all patients three months after injury. Results-Stepwise multiple regression analysis wa s performed with the RPQ score at three months as the dependent measur e. A combination of eight of the scores from the early measures gave a multiple correlation coefficient of R = 0.86 accounting for 74% of th e variance in RPQ scores. The most predictive individual measures were the HADS and IES. Regression analysis with RPQ score at 7-10 days as dependent measure showed that 10 of the scores gave a coefficient of R = 0.84 accounting for 71% of the variance. Conclusions-A combination of measures may significantly aid the prediction of persistent PCS. Fi ve measures: HADS, post-traumatic amnesia, SOMC, PASAT, and RPQ are re commended for their predictive value and clinical utility. Independent cross validation studies are required before these results can be gen erally applied. They do, however, provide valuable indications regardi ng those measures that are most likely to demonstrate utility.