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Cited by 148Traumatic Brain Injury ResearchLong-Term Effects of COVID-19Traumatic Brain Injury and Neurovascular Disturbances

Postconcussion syndrome: demographics and predictors in 221 patients

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Tator, Charles H., Davis, Hannah S., Dufort, Paul A., Tartaglia, Maria Carmella, Davis, Karen D., Ebraheem, Ahmed, Hiploylee, Carmen·2016·Journal of Neurosurgery
DOI 10.3171/2015.6.jns15664
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Abstract

OBJECTIVE: The objective of this study was to determine the demographics and predictors of postconcussion syndrome (PCS) in a large series of patients using a novel definition of PCS. METHODS: The authors conducted a retrospective cohort study of 284 consecutive concussed patients, 221 of whom had PCS on the basis of at least 3 symptoms persisting at least 1 month. This definition of PCS was uniformly employed and is unique in accepting an expanded list of symptoms, in shortening the postconcussion interval to 1 month from 3 months, and in excluding those with focal injuries such as hemorrhages and contusions. RESULTS: The 221 cases showed considerable heterogeneity in clinical features of PCS. They averaged 3.3 concussions, with a range of 0 to 12 or more concussions, and 62.4% occurred during sports and recreation. The median duration of PCS was 7 months at the time of examination, with 11.8% lasting more than 2 years, and 23.1% with PCS had only 1 concussion. The average patient age was 27 years (range 10–74 years). The average number of persistent symptoms was 8.1; 26.2% had a previous psychiatric condition, attention-deficit disorder/attention-deficit hyperactivity disorder, a learning disability, or previous migraine headaches. The prevalence of arachnoid cysts and Chiari malformation in PCS exceeded the general population. Additionally, involvement in litigation, presence of extracranial injuries, amnesia and/or loss of consciousness, and female sex were predictive of reporting a high number of symptoms. A prior history of psychiatric conditions or migraines, cause of injury, number of previous concussions, and age did not significantly predict symptom number. Only the number of symptoms reported predicted the duration of PCS. To predict the number of symptoms for those who fulfilled PCS criteria according to the International Classification of Diseases, 10th Revision (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), the number of previous concussions was significant. CONCLUSIONS: PCS is commonly associated with multiple concussions, but 23.1% in the present series occurred after only 1 concussion. Most patients with PCS had multiple symptoms persisting for months or years. The median duration of PCS was 7 months, with a range up to 26 years. In only 11.3%, the PCS had ended at the time of consultation. Not all predictors commonly cited in the literature align with the findings in this study. This is likely due to differences in the definitions of PCS used in research. These results suggest that the use of ICD-10 and DSM-IV to diagnose PCS may be biased toward those who are vulnerable to concussions or with more severe forms of PCS. It is thus important to redefine PCS based on evidence-based medicine.

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Authors
Tator, C. H., Davis, H. S., Dufort, P. A., Tartaglia, M. C., Davis, K. D., Ebraheem, A., & Hiploylee, C.
Affiliations
  • Toronto Western Hospital (CA)
  • Canadian Concussion Centre, Toronto Western Hospital; and
  • University of Toronto (CA)
ORCID
Venue
Journal of Neurosurgery
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2016-11
Volume
125
Issue
5
Pages
1206-1216
ISSN
  • 0022-3085 (ISSN-L)
  • 1933-0693
DOI
10.3171/2015.6.jns15664
OpenAlex
W2282595924
Cited by
148
References
42
Citations by year
2026: 7 · 2025: 10 · 2024: 17 · 2023: 13 · 2022: 21 · 2021: 15 · 2020: 22 · 2019: 12 · 2018: 10 · 2017: 14 · 2016: 6
FWCI
13.14
Type
journal article
Language
en
Open access
Locations
  • Journal of neurosurgery (publishedVersion)
  • PubMed (publishedVersion)
Funders
American Psychiatric Publishing
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Keywords
post-concussion syndrome, concussion, multiple concussions, symptom duration, predictors of symptom severity, arachnoid cyst, Chiari malformation, litigation, extracranial injuries, female sex, sports-related head injury, psychiatric comorbidity, migraine, ICD-10, DSM-IV
MeSH terms
Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Cohort Studies, Post-Concussion Syndrome, Young Adult

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