Skip to main content
×
×
Home

Do Mild Traumatic Brain Injury Severity Sub-classification Systems Help to Identify People Who Go on to Experience Long-Term Symptoms?

  • Alice Theadom (a1), Suzanne Barker-Collo (a2), Andrea Greenwood (a2), Priya Parmar (a1), Kelly Jones (a1), Nicola Starkey (a3), Kathryn McPherson (a4) and Valery L. Feigin (a1)...
Abstract

Objective: To identify the systems available to sub-classify mild traumatic brain injury (TBI) and to determine their utility in predicting 1-year outcome.

Methods: A systematic review to identify mild-TBI sub-classification systems was conducted until March 2016. The identified systems were applied to a cohort of N = 290 adults who had experienced a mild-TBI, and who had been assessed for post-concussion symptoms 1-year post injury. ANOVAs and regression models were used to determine whether each sub-classification system could distinguish between outcomes and to explore their contribution to explaining variance in post-concussion symptoms 1-year post injury.

Results: Nineteen sub-classification systems for mild-TBI met the inclusion criteria for this review. The Saal (1991) classification system significantly differentiated the experience of post-concussion symptoms in our cohort 1-year post injury (F = 2.39, p = 0.05). However, the findings did not remain significant following correction for multiple comparisons and inclusion of socio-demographic and contextual factors in the regression model.

Conclusions: Current sub-classification systems fail to explain much of the variance in post-concussion symptoms 1 year following mild-TBI. Further research is needed to identify the factors (including socio-demographic and contextual factors) to determine, who may be at risk of developing persistent post-concussion symptoms.

Copyright
Corresponding author
Address for correspondence: Alice Theadom, PhD, National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, AUT North Shore Campus, AR417, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland 1142, New Zealand. E-mail: alice.theadom@aut.ac.nz
References
Hide All
American Academy of Neurology (1997). Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology, 48 (3), 581585.
Anderson, T., Heitger, M., & MacLeod, A. D. (2006). Concussion and mild head injury. Practical Neurology, 6 (6), 342357.
Andrade, A. F., Paiva, W. S., Soares, M. S., De Amorim, R. L., Tavares, W. M., & Teixeira, M. J. (2011). Classification and management of mild head trauma. International Journal of General Medicine, 27 (4), 175179.
Belanger, H. G., Vanderploeg, R. D., Curtiss, G., & Warden, D. L. (2007). Recent neuroimaging techniques in mild traumatic brain injury. The Journal of Neuropsychiatry and Clinical Neurosciences, 19 (1), 520.
Buck, P. W., Laster, R. G., Sagrati, J. S., & Kirzner, R. S. (2012). Working with mild traumatic brain injury: voices from the field. Rehabilitation Research and Practice, Feb 7, 16.
Cantu, R. C. (2001). Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36 (3), 244248.
Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, Feb (Suppl. 43), 113125.
Cassidy, J. D., Carroll, L. J., Peloso, P. M., Borg, J., von Holst, H., Holm, L., . . . Coronado, V. G. (2004). Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, Feb (Suppl. 43), 2860.
Culotta, V., Sementilli, M. E., Gerold, K., & Watts, C. C. (1996). Clinicopathological heterogeneity in the classification of mild head injury. Neurosurgery, 38 (2), 245250.
De Kruijk, J. R., Leffers, P., Menheere, P. P., Meerhoff, S., Rutten, J., & Twijnstra, A. (2002). Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. Journal of Neurology, Neurosurgery and Psychiatry, 73 (6), 727732.
Feigin, V. F., Theadom, A., Barker-Collo, S. L., Starkey, N., McPherson, K., Kahan, M., . . . on behalf of the BIONIC Research Group. (2013). Incidence of traumatic brain injury in New Zealand: a population-based study. The Lancet Neurology, 12 (1), 5364.
Galetta, K. M., Barrett, J., Allen, M., Madda, F., Delicata, D., Tennant, A. T., . . . Balcer, L. J. (2011). The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology, 76 (17), 14561462.
Guskiewicz, K. M. (2001). Concussion in sport: the grading-system dilemma. Athletic Therapy Today, 6 (1), 1827.
Hawryluk, G. W. J., & Manley, G. T. (2015). Part 1. Classification of traumatic brain injury: past, present and future. Handbook of Clinical Neurology, In Grafman, J. & Salazar, A.M. Elsevier (Eds.), Vol. 127, pp. 1521.
Hugenholtz, H., & Richard, M. T. (1982). Return to athletic competition following concussion. Canadian Medical Association Journal, 127 (9), 827829.
Iverson, G. L. (2005). Outcome from mild traumatic brain injury. Current opinion in psychiatry, 18 (3), 301317.
Iverson, G. L. (2010). Mild traumatic brain injury meta-analyses can obscure individual differences. Brain Injury, 24 (10), 12461255.
Jacobs, B., Beems, T., Stulemeijer, M., van Vugt, A. B., van der Vliet, T. M., Borm, G. F., & Vos, P. E. (2010). Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities. Journal of Neurotrauma, 27 (4), 655668.
Jordan, B. J., & Tsairis, P. T. (1989). Sports neurology (Vol. 227). Gaithersburg, MD: Aspen Publishers.
Kelly, J. P., Nichols, J. S., Filley, C. M., Lillehei, K. O., Rubinstein, D., & Kleinschmidt-DeMasters, B. K. (1991). Concussion in sports: guidelines for the prevention of catastrphic outcome. Journal of the American Medical Association, 266 (20), 28672869.
King, N. S., Crawford, S., Wenden, F. J., Caldwell, F. E., & Wade, D. T. (1999). Early prediction of persisting post-concussion symptoms following mild and moderate head injuries. British Journal of Clinical Psychology, 38 (1), 1525.
King, N. S., Crawford, S., Wenden, F. J., Moss, N. E., & Wade, D. T. (1995). The rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242 (9), 587592.
Lannsjo, M., Geijerstam, J. L., Johansson, U., Bring, J., & Borg, J. (2009). Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort. Brain Injury, 23 (3), 213219.
Leclerc, S., Lassonde, M., Delaney, S., Lacroix, V. J., & Johnston, K. M. (2001). Recommendations for the grading of concussion in athletes. Sports Medicine, 31 (8), 629636.
Lingsma, H., Yue, J. K., Maas, A., Steyerberg, E. W., Manley, G. T. M. D. P. D., Cooper, S. R., . . . Yuh, E. L. (2015). Outcome prediction after mild and complicated mild traumatic brain injury: external validation of existing models and identification of new predictors using the TRACK-TBI pilot study. Journal of Neurotrauma, 32 (2), 8394.
Malec, J. F., Brown, A. W., Leibson, C. L., Flaada, J. T., Mandrekar, J. N., Diehl, N. N., & Perkins, P. K. (2007). The mayo classification system for traumatic brain injury severity. Journal of Neurotrauma, 24 (9), 14171424.
Maroon, J. C., Steele, P. B., & Berlin, R. (1980). Football head and neck injuries – an update. Clinical Neurosurgery, 27, 414429.
Marosszeky, N. E. V., Ryan, L., Shores, E. A., Batchelor, J., & Marosszeky, J. E. (1997). The PTA Protocol: Guidelines for using the Westmead Post-Traumatic Amnesia (PTA) Scale. Sydney: Wild & Wooley.
Marshall, S., Bayley, M., McCullagh, S., Velikonja, D., Berrigan, L., Ouchterlony, D., . . . on behalf of the mTBI Expert Consensus Group. (2015). Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Injury, 29 (6), 688700.
McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R. J., . . . Turner, M. (2013). Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. British Journal of Sports Medicine, 47 (5), 259262.
McMahon, P., Hricik, A., Yue, J. K., Puccio, A. M., Inoue, T., Lingsma, H. F., . . . Vassar, M. J. (2014). Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective track-TBI study. Journal of Neurotrauma, 31 (1), 2633.
Menon, D. K., Schwab, K., Wright, D. W., Maas, A. I., & The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. (2010). Position statement: definition of traumatic brain injury. Archives of Physical Medicine & Rehabilitation, 91 (11), 16371640.
Morris, P. G., Prior, L., Shoumitro, D., Lewis, G., Mayle, W., Burrow, C. E., & Bryant, E. (2005). Patients' views on outcome following head injury: a qualitative study. BMC Family Practice, 6 (30).
Nelson, W. E., Jane, J. A., & Gieck, J. H. (1984). Minor head injury in sports: a new system of classification and management. Physician Sports Medicine, 12 (3), 103107.
Ommaya, A. K. (1985). Biomechanis of head injury: experimental aspects. In Nahum, A.M. & Melvin, J. (Eds.), The biomechanics of trauma (pp. 245269). Norwalk, Conneticut: Appleton-Century-Crofts.
Rapp, P. E., & Curley, K. C. (2012). Is a diagnosis of “mild traumatic brain injury” a category mistake?. Journal of Trauma and Acute Care Surgery, 73 (2 Suppl. 1), S13–23. doi:10.1097/TA.0b013e318260604b
Roberts, W. (1992). Who plays? Who sits? Managing concussions in sport. Physician Sports Medicine, 20 (6), 6672.
Røe, C., Sveen, U., Alvsåker, K., & Bautz-Holter, E. (2009). Post-concussion symptoms after mild traumatic brain injury: influence of demographic factors and injury severity in a 1-year cohort study. Disability and Rehabilitation, 31 (15), 12351243.
Ruff, R. M., & Jurica, P. (1999). In search of a unified definition for mild traumatic brain injury. Brain Injury, 13 (12), 943952.
Saal, J. A. (1991). Common American football injuries. Sports Medicine, 12 (2), 132147.
Saban, K. L., Hogan, N. S., Hogan, T. P., & Pape, T. L. (2015). He looks normal but . . . challenges of family caregivers of veterans diagnosed with a traumatic brain injury. Rehabilitation Nursing, 40 (5), 277285.
Scheenen, M. E. Spikman, J. M., de Koning, M. E., van der Horn, J. J., Roks, G., Hageman, G., & van der Naalt, J. (2017). Patients “At Risk” of suffering from persistent complaints after mild traumatic brain injury: the role of coping, mood disorders, and post-traumatic stress. Neurotrauma, 34 (1), 3137.
Schneider, R. C., & Kriss, F. C. (1973). First aid and diganosis – the treatment of head injuries. In Schneider, R.C. (Ed.), Head and neck injuries in football: mechanisms, treatment and prevention (pp. 163187). Baltimore, MA: Williams and Wilkins Co.
Servadei, F., Teasdale, G., & Merry, G. (2001). Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis and management. Journal of Neurotrauma, 18 (7), 657664.
Stein, S. C., & Spettell, C. (1995). The Head Injury Severity Scale (HISS): a practical classification of closed-head injury. Brain Injury, 9 (5), 437444.
Studerus-Germann, A. M., Thiran, J. P., Daducci, A., & Gautschi, O. P. (2016). Diagnostic approaches to predict persistent post-traumatic symptoms after mild traumatic brain injury – a literature review. International Journal of Neuroscience, 126 (4), 289298.
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2 (7872), 8184.
Tellier, A., Della Malva, L. C., Cwinn, A., Grahovac, S., Morrish, W., & Brennan-Barnes, M. (1991). Mild head injury: a misnomer. Brain Injury, 13 (7), 463475.
Theadom, A., Barker-Collo, S., Feigin, V., Starkey, N., Jones, K., Jones, A., . . . on behalf of the BIONIC Research Group. (2012). The spectrum captured: a methodological approach to studying incidence and outcomes of traumatic brain injury on a population level. Neuroepidemiology, 38 (1), 1829.
Theadom, A., Parag, V., Dowell, T., McPherson, K., Starkey, N., Barker-Collo, S., . . . Group, B. R. (2016). Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. British Journal of General Practice, 66 (642), e16–23.
Torg, J. S. (1991). Athletic injuries to the head, neck and face. St Louis, MO: Mosby Year Book: 226.
Vos, P. E., Battistin, L., Birbamer, G., Gerstenbrand, F., Potapov, A., Prevec, T., . . . von Wild, K. (2002). EFNS guideline on mild traumatic brain injury: report of an EFNS task force. European Journal of Neurology, 9 (3), 207219.
Wilberger, J. E., & Maroon, J. C. (1989). Head injuries in athletes. Clinics in Sports Medicine, 8 (1), 19.
Zumstein, M. A., Moser, M., Mottini, M., Ott, S. R., Sadowski-Cron, C., Radanov, B. P., . . . Exadaktylos, A. (2011). Long-term outcome in patients with mild traumatic brain injury: a prospective observational study. Journal of Trauma, 7 (1), 120127.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Brain Impairment
  • ISSN: 1443-9646
  • EISSN: 1839-5252
  • URL: /core/journals/brain-impairment
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 9
Total number of PDF views: 63 *
Loading metrics...

Abstract views

Total abstract views: 489 *
Loading metrics...

* Views captured on Cambridge Core between 6th July 2017 - 19th August 2018. This data will be updated every 24 hours.