Mild traumatic brain injuries : the impact of early intervention on late sequelae

Abstract: Aims:Studies I & II:To assess the incidence of Traumatic Brain Injuries (TBI) in western Sweden and to investigate health-related quality of life and post-concussion symptoms (PCS).Study III: To test the hypothesis that a programme of early rehabilitation for selected Mild Traumatic Brain Injury (MTBI) patients would reduce late sequelae.Study IV: To investigate the parallel reliability, concurrent validity and inter-observer reliability of the Post-Concussion Symptoms Questionnaire (PCSQ).Methods:Studies I & II: Data were collected prospectively and retrospectively. 173 patients aged between 16 and 60 and collected consecutively at Södra Älvsborg Hospital received two mailed questionnaires three months and one year after injury.Study III: 1719 patients were registered at Södra Älvsborg Hospital and 395 MTBI patients were selected. Patients allocated to the control group (n=131) received regular care. Patients assigned to intervention (n=264) were contacted 2-8 weeks (median 3 weeks) after injury and offered rehabilitation. The intervention was designed according to their perceived individual needs. Outcome was measured as the change in the occurrence of PCS, life satisfaction, health-related quality of life and daily activities one year after injury, as compared with before injury for the different groups.Study IV: In the parallel reliability and concurrent validity study, 35 patients filled in the PCSQ, answering, “Yes” or “No”. The patients were than interviewed to check the certain “Yes” or “No” answers. In the inter-observer study, the observers filled in their ratings independently.Results:Studies I & II: 753 cases were identified, representing an incidence of 546 per 100,000 a year in western Sweden. A statistically-significant correlation was found between an increasing number of PCS and reduced health-related quality of life.Study III: No statistical differences were found between the intervention and control groups with respect to intervention. Patients who experienced few PCS 2-8 weeks (median 3 weeks) after the injury and declined rehabilitation recovered and returned to their pre-injury status. Patients who suffered several PCS and accepted rehabilitation did not recover during the period of one year.Study IV: The parallel reliability and concurrent validity ranged from 82-100 per cent of agreement between the two questionnaires. The range of agreement was 93-100 per cent in the inter-observer study.Conclusions:Study I: The incidence of TBI is high in western Sweden, 546 per 100,000.Study II: There is a statistically-significant correlation between a higher increase in the number of PCS and reduced health-related quality of life.Study III: In this particular MTBI sample, early active rehabilitation did not change the outcome to a statistically-significant degree.Study IV. The PCSQ is a reliable and valid instrument for screening PCS after an MTBI.