Mild traumatic brain injury in New Zealand: factors influencing post-concussion symptom recovery time in a specialised concussion service
Rachel H. J. Forrest 1 , Janis D. Henry 2 , Penelope J. McGarry 2 , Robert N. Marshall 31 Faculty of Education, Humanities and Health Science, Eastern Institute of Technology, Hawke’s Bay Campus, Taradale, Napier, New Zealand
2 National Service Managers, Auckland Concussion Service, Mt Eden, Auckland, New Zealand
3 Eastern Institute of Technology, Hawke’s Bay Campus, Taradale, Napier, New Zealand
Correspondence to: Rachel H. J. Forrest, Faculty of Education, Humanities and Health Science, Eastern Institute of Technology, Hawke’s Bay Campus, 501 Gloucester Street, Taradale, Napier 4112, New Zealand. Email: rforrest@eit.ac.nz
Journal of Primary Health Care 10(2) 159-166 https://doi.org/10.1071/HC17071
Published: 28 June 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: By 2020, traumatic brain injuries (TBIs) are predicted to become the third largest cause of disease burden globally; 90% of these being mild traumatic brain injury (mTBI). Some patients will develop post-concussion syndrome.
AIM: To determine whether the time between sustaining a mTBI and the initial assessment by a specialised concussion service, along with the post-concussion symptoms reported at the assessment, affected recovery time.
METHODS: A retrospective medical record review of clients who had completed the Rivermead Post-Concussion Questionnaire (RPQ) at their initial assessment and were discharged from a large metropolitan concussion service in New Zealand was undertaken over a 6-month period in 2014 (n = 107). Using correlations, General Linear Mixed-effects Models (GLMM) and linear regressions, we explored associations between factors including ethnicity, gender and accident type, along with individual RPQ symptom scores and cluster scores, with time from injury to initial assessment by the specialised concussion service and initial assessment to discharge.
RESULTS: Time from injury to initial assessment by a specialist concussion service was correlated with proportionally more psychological symptoms present at initial assessments (r = 0.222, P = 0.024); in particular, feeling depressed or tearful (r = 0.292, P = 0.003). Time to discharge was correlated with individual RPQ symptom proportions present at initial assessment for headaches (r = –0.238, P = 0.015), sensitivity to noise (r = 0.220, P = 0.026), feeling depressed or tearful (r = 0.193, P = 0.051) and feeling frustrated or impatient (r = 0.252, P = 0.003), along with the psychological cluster proportion (r = 0.235, P = 0.017) and the total RPQ score (r = 0.425, P < 0.001).
CONCLUSION: Prompt diagnosis and treatment of mTBI may minimise the severity of post-concussion symptoms, especially symptoms associated with mental health and wellbeing.
KEYWORDS: Concussion; mild traumatic brain injury; mTBI; recovery; Rivermead Post-Concussion Questionnaire; Rivermead Symptom Checklist
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