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Symptoms following concussion could be PTSD

Patients may have posttraumatic stress disorder following a mild traumatic brain injury and not postconcussion syndrome, according to recent study findings published in JAMA Psychiatry.

Emmanuel Lagarde, PhD, of the Université de Bordeaux in France, and colleagues evaluated 534 patients with mild traumatic brain injury (MTBI) and 827 controls with nonhead injuries. Injuries on the face (n=118) were the most common location of other injury among patients with MTBI, followed by skin injuries (n=97) and lower limb injuries (n=38). Among controls, the most common injury was on lower limbs (n=292), followed by upper limbs (n=285) and skin (n=84).

Emmanuel Lagarde

Participants with MTBI were more likely to fulfill the criteria for postconcussion syndrome (PCS; 21.1%) vs. controls (16.3%). Similarly, participants with MTBI were more likely to fulfill the diagnostic criteria for PTSD (8.8%) vs. controls (2.2%).

MTBI did not seem to predict PCS (OR=1.13; 95% CI, 0.82-1.55); however, it predicted PTSD (OR=4.47; 95% CI, 2.38-8.4). Men were less likely to report PTSD than women. Other predictors of PTSD included assault, road crash and nonhead-injury Abbreviated Injury Score (AIS) of 2. PCS was predicted by assault and previous poor health.

“This prospective study of the 3-month PCS and PTSD symptoms of mild head- and nonhead-injured patients recruited at the ED showed that the rationale to define a PCS that is specific to head-trauma patients is weak,” the researchers wrote. “Our results also suggested that the misunderstanding related to the relevance of defining such a syndrome could be explained by the overlapping pattern with symptoms of the PTSD hyper-arousal dimension. Further use of PCS in head-injury patients has important consequences in terms of treatment, insurance resource allocation, and advice provided to patients and their families. Our results also stressed the importance of considering PTSD risk and treatment for patients with MTBI.”

Emmanuel Lagarde, PhD, can be reached at emmanual.lagarde@isped.u-bordeaux2.fr.

Disclosure: The study was funded in part by the Bordeaux University Hospital, INSERM, and the REUNICA Group.