PERSISTENT POSTCONCUSSION SYNDROME - THE STRUCTURE OF SUBJECTIVE COMPLAINTS AFTER MILD TRAUMATIC BRAIN INJURY

Objective: To examine the structure of persistent postconcussive sympt oms in a sample of patients with mild traumatic brain injury. Design: Multivariate discriminant analysis in a series of 50 consecutive clini cal referrals evaluated for postconcussive symptoms, neuropsychologica l functioning, and personality and emotional functioning at least 3 mo nths after injury; follow-up information regarding level of disability was obtained for 37 patients at least 1 year after injury. Setting: N europsychology clinic affiliated with a comprehensive brain trauma reh abilitation center. Patients: 50 consecutively referred patients with a diagnosis of mild traumatic brain injury referred by physicians, reh abilitation nurses, or attorneys because of persistent deficits or sub jective complaints consistent with a postconcussion syndrome. Main Out come Measure: Postconcussive symptoms endorsed on the Post Mild Trauma tic Brain Injury Symptom Checklist. Results: Pour factors consisting o f multiple symptoms were identified: cognitive factor, affective facto r, somatic factor, and sensory factor. Using these four factors, K-mea ns cluster analysis of subjects was applied to classify patients. Pati ent clusters consisted of those with minimal symptoms, those with prim arily cognitive-affective symptoms, those with prominent somatic sympt oms, and those with severe global symptoms (P = .000). Patient symptom clusters were largely unrelated to neurological or neuropsychological functioning. The presence of chronic disability and resumption of pro ductive functioning differed significantly among groups (P = .003). Co nclusions: Subjective complaints provide clinically meaningful informa tion and are strongly related to the nature and extent of disability a fter mild traumatic brain injury. Characterization of a single postcon cussive syndrome may be misleading, and it may be more meaningful to d efine a number of postconcussive syndromes with differing symptom prof iles and recovery.