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Open AccessArticle

Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Concussion Symptoms after Traumatic Brain Injury

1
Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
2
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
3
Department of Medical Statistics, University Medical Center Göttingen, 37073 Göttingen, Germany
4
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway
5
Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models, 0373 Oslo, Norway
*
Author to whom correspondence should be addressed.
The CENTER-TBI participants and investigators are provided in the Supplementary file.
J. Clin. Med. 2020, 9(6), 1931; https://doi.org/10.3390/jcm9061931
Received: 5 May 2020 / Revised: 15 June 2020 / Accepted: 17 June 2020 / Published: 19 June 2020
(This article belongs to the Section Epidemiology & Public Health)
Background: Post-concussion symptoms (PCS) are often reported as consequences of mild and moderate traumatic brain injury (TBI), but these symptoms are not well documented in severe TBI. There is a lack of agreement as to which factors and covariates affect the occurrence, frequency, and intensity of PCS among TBI severity groups. The present study therefore aims to examine the association between sociodemographic, premorbid, and injury-related factors and PCS. Methods: A total of 1391 individuals (65% male) from the CENTER-TBI study were included in the analyses. The occurrence, frequency (number of PCS), and intensity (severity) of PCS were assessed using the Rivermead Post-concussion Symptoms Questionnaire (RPQ) at six months after TBI. To examine the association between selected factors (age, sex, living situation, employment status, educational background, injury and TBI severity, and premorbid problems) and PCS, a zero-inflated negative binomial model (ZINB) for occurrence and frequency of PCS and a standard negative binomial regression (NB) for intensity were applied. Results: Of the total sample, 72% of individuals after TBI reported suffering from some form of PCS, with fatigue being the most frequent among all TBI severity groups, followed by forgetfulness, and poor concentration. Different factors contributed to the probability of occurrence, frequency, and intensity of PCS. While the occurrence of PCS seemed to be independent of the age and sex of the individuals, both the frequency and intensity of PCS are associated with them. Both injury and TBI severity influence the occurrence and frequency of PCS, but are associated less with its intensity (except “acute” symptoms such as nausea, vomiting, and headaches). Analyses focusing on the mTBI subgroup only yielded results comparable to those of the total sample. Discussion: In line with previous studies, the results support a multifactorial etiology of PCS and show the importance of differentiating between their occurrence, frequency, and intensity to better provide appropriate treatment for individual subgroups with different symptoms (e.g., multiple PCS or more intense PCS). Although PCS often occur in mild to moderate TBI, individuals after severe TBI also suffer from PCS or post-concussion-like symptoms that require appropriate treatment. The chosen statistical approaches (i.e., ZINB and NB models) permit an ameliorated differentiation between outcomes (occurrence, frequency, and intensity of PCS) and should be used more widely in TBI research. View Full-Text
Keywords: RPQ; post-concussion symptoms; traumatic brain injury; negative binomial model; zero-inflated negative binomial model RPQ; post-concussion symptoms; traumatic brain injury; negative binomial model; zero-inflated negative binomial model
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MDPI and ACS Style

Zeldovich, M.; Wu, Y.-J.; Gorbunova, A.; Mikolic, A.; Polinder, S.; Plass, A.M.; Covic, A.; Asendorf, T.; Andelic, N.; Voormolen, D.C.; von Steinbüchel, N.; o.b.o.t.C.-T.7 P.a.I. Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Concussion Symptoms after Traumatic Brain Injury. J. Clin. Med. 2020, 9, 1931. https://doi.org/10.3390/jcm9061931

AMA Style

Zeldovich M, Wu Y-J, Gorbunova A, Mikolic A, Polinder S, Plass AM, Covic A, Asendorf T, Andelic N, Voormolen DC, von Steinbüchel N, obotC-T7PaI. Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Concussion Symptoms after Traumatic Brain Injury. Journal of Clinical Medicine. 2020; 9(6):1931. https://doi.org/10.3390/jcm9061931

Chicago/Turabian Style

Zeldovich, Marina; Wu, Yi-Jhen; Gorbunova, Anastasia; Mikolic, Ana; Polinder, Suzanne; Plass, Anne M.; Covic, Amra; Asendorf, Thomas; Andelic, Nada; Voormolen, Daphne C.; von Steinbüchel, Nicole; on behalf of the CENTER-TBI 7 Participants and Investigators. 2020. "Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Concussion Symptoms after Traumatic Brain Injury" J. Clin. Med. 9, no. 6: 1931. https://doi.org/10.3390/jcm9061931

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