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Published in: European Journal of Trauma and Emergency Surgery 6/2017

01-12-2017 | Original Article

Post-concussive syndrome after mild head trauma: epidemiological features in Tunisia

Authors: O. Chakroun-Walha, I. Rejeb, M. Boujelben, K. Chtara, A. Mtibaa, H. Ksibi, A. Chaari, M. Bouaziz, N. Rekik

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2017

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Abstract

Background

Minor head injury is one of the major diagnoses requiring management in emergency departments (ED) but its squeals are not well studied in our country.

Objective

To describe the prevalence of post-concussive syndrome and its impacts on life activities, up to 6 months of follow-up, among patients having a minor head injury and discharged from ED.

Methods

A prospective bi-centric study including adults having a minor head trauma and consenting to be followed up to 6 months after discharge. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) was used at baseline, after 15 days, at 1 month, at 3 months and at 6 months post-injury to assess concussive symptoms. We also used the Rivermead Head Injury Follow-up Questionnaire (RHFUQ) to describe impacts of minor head trauma on life activities.

Results

There were 130 consenting patients at baseline interview. Proportion of patients describing post-concussive symptoms at baseline was 71/130. At 6 months of follow-up, post-concussive syndrome was diagnosed among 21.4 % of participants. Sustaining symptoms at 6 months post-injury were mainly anger and irritability (12.5 %). Correlations between high RPQ sum rates since 15 days’ post-injury call and the sum total rates of RHFUQ were significant. The major significant impact of minor head trauma at 6 months of follow-up was among domestic activities.

Conclusion

The two most important findings of this study were the huge proportion of patients having minor head injury and discharged from ED without any explanation of possible symptoms after head trauma and the unknown impacts on life activities.
Literature
1.
go back to reference Tazarourte K, Macaine C, Didane H et al. Traumatisme crânien non grave. EMC, Médecine d’urgence. Ed Masson, Paris, 2007. 25-200-C-10. Tazarourte K, Macaine C, Didane H et al. Traumatisme crânien non grave. EMC, Médecine d’urgence. Ed Masson, Paris, 2007. 25-200-C-10.
2.
go back to reference Traumatisme crânien léger (score de Glasgow de 13 à 15): triage, évaluation, examens complémentaires et prise en charge précoce chez le nouveau-né, l’enfant et l’adulte. Société française de médecine d’urgence. E. Jehlé, D. Honnart, C. Grasleguen et al. Ann Fr Med Urgence. 2012 2;199–214. Traumatisme crânien léger (score de Glasgow de 13 à 15): triage, évaluation, examens complémentaires et prise en charge précoce chez le nouveau-né, l’enfant et l’adulte. Société française de médecine d’urgence. E. Jehlé, D. Honnart, C. Grasleguen et al. Ann Fr Med Urgence. 2012 2;199–214.
3.
go back to reference Cunningham J, Brison R, Pickett W. Concussive symptoms in emergency department patients diagnosed with minor head injury. J Emerg Med. 2011;40(3):262–6.CrossRefPubMed Cunningham J, Brison R, Pickett W. Concussive symptoms in emergency department patients diagnosed with minor head injury. J Emerg Med. 2011;40(3):262–6.CrossRefPubMed
4.
go back to reference Lannsjö M, Borg J, Björklund G, et al. Internal construct validity of Rivermead post-concussion symptoms questionnaire. J Rehabil Med. 2011;43:997–1002.CrossRefPubMed Lannsjö M, Borg J, Björklund G, et al. Internal construct validity of Rivermead post-concussion symptoms questionnaire. J Rehabil Med. 2011;43:997–1002.CrossRefPubMed
5.
go back to reference King NS, Crawford S, Wenden FJ, et al. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. 1995;242:587–92.CrossRefPubMed King NS, Crawford S, Wenden FJ, et al. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. 1995;242:587–92.CrossRefPubMed
6.
go back to reference Moss NEG, Crawford S, Wade DT. Post-concussion symptoms: is stress a mediating factor? Clin Rehabil. 1994;8:149–56.CrossRef Moss NEG, Crawford S, Wade DT. Post-concussion symptoms: is stress a mediating factor? Clin Rehabil. 1994;8:149–56.CrossRef
7.
go back to reference Crawford S, Wenden FJ, Wade DT. The Rivermead head injury follow up questionnaire: a study of a new rating scale and other measure to evaluate outcome after head injury. J Neurol Neurosurg Psychiatry. 1996;60:510–4.CrossRefPubMedPubMedCentral Crawford S, Wenden FJ, Wade DT. The Rivermead head injury follow up questionnaire: a study of a new rating scale and other measure to evaluate outcome after head injury. J Neurol Neurosurg Psychiatry. 1996;60:510–4.CrossRefPubMedPubMedCentral
8.
go back to reference Ruff RM, Levin HS, Marshall LF. Neurobehavioral methods of assessment and the study of outcome in minor head injury. J Head Trauma Rehabil. 1986;1:43–52.CrossRef Ruff RM, Levin HS, Marshall LF. Neurobehavioral methods of assessment and the study of outcome in minor head injury. J Head Trauma Rehabil. 1986;1:43–52.CrossRef
10.
go back to reference Cicerone KD, Kalmar K. Persistent postconcussion syndrome: the structure of subjective complaints after mild traumatic brain injury. J Head Trauma Rehabil. 1995;10:1–17.CrossRef Cicerone KD, Kalmar K. Persistent postconcussion syndrome: the structure of subjective complaints after mild traumatic brain injury. J Head Trauma Rehabil. 1995;10:1–17.CrossRef
11.
go back to reference Van der naalt J, Van Zomeren AH, Sluiter WJ, et al. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry 1999;66:207–13. Van der naalt J, Van Zomeren AH, Sluiter WJ, et al. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry 1999;66:207–13.
13.
go back to reference Ramos-Zuniga R, Gonzalez-de la Torre M, Jimenez-Maldonad M et al. Postconcussion syndrome and mild head injury: the role of early diagnosis using neuropsychological tests and functional magnetic resonance/spectroscopy. World Neurosurg. 2014. [article inpress]. Ramos-Zuniga R, Gonzalez-de la Torre M, Jimenez-Maldonad M et al. Postconcussion syndrome and mild head injury: the role of early diagnosis using neuropsychological tests and functional magnetic resonance/spectroscopy. World Neurosurg. 2014. [article inpress].
14.
15.
go back to reference Binder LM. Persisting symptoms after mild head injury: a review of the postconcussive syndrome. J Clin Exp Neuropsychol. 1986;8:323–46.CrossRefPubMed Binder LM. Persisting symptoms after mild head injury: a review of the postconcussive syndrome. J Clin Exp Neuropsychol. 1986;8:323–46.CrossRefPubMed
17.
go back to reference Evans RW. The postconcussion syndrome and the sequelae of mild head injury. Neurol Clin. 1992;10:815–47.PubMed Evans RW. The postconcussion syndrome and the sequelae of mild head injury. Neurol Clin. 1992;10:815–47.PubMed
18.
go back to reference Evans RW. The postconcussion syndrome and whiplash injuries: a question and answer review for primary care physicians. Prim Care. 2004;31:1–17.CrossRefPubMed Evans RW. The postconcussion syndrome and whiplash injuries: a question and answer review for primary care physicians. Prim Care. 2004;31:1–17.CrossRefPubMed
19.
go back to reference Margulies S. The postconcussion syndrome after mild head trauma: is brain damage overdiagnosed? Part 1. J Clin Neurosci. 2000;7:400–8.CrossRefPubMed Margulies S. The postconcussion syndrome after mild head trauma: is brain damage overdiagnosed? Part 1. J Clin Neurosci. 2000;7:400–8.CrossRefPubMed
20.
go back to reference Niogi SN, Mukherjee P, Ghajar J, et al. Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion tensor imaging study of mild traumatic brain injury. AJNR Am J Neuroradiol. 2008;29:967–73.CrossRefPubMed Niogi SN, Mukherjee P, Ghajar J, et al. Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion tensor imaging study of mild traumatic brain injury. AJNR Am J Neuroradiol. 2008;29:967–73.CrossRefPubMed
21.
go back to reference Perea-Bartolome MV, Ladera-Fernandez V, Morales-Ramos F. Mnemonic performance in mild traumatic brain injury. Rev Neurol. 2002;35:607–12.PubMed Perea-Bartolome MV, Ladera-Fernandez V, Morales-Ramos F. Mnemonic performance in mild traumatic brain injury. Rev Neurol. 2002;35:607–12.PubMed
22.
go back to reference Szymanski HV, Linn R. A review of the postconcussion syndrome. Int J Psychiatry Med. 1992;22:357–75.CrossRefPubMed Szymanski HV, Linn R. A review of the postconcussion syndrome. Int J Psychiatry Med. 1992;22:357–75.CrossRefPubMed
23.
go back to reference Arciniegas DB, Anderson CA, Topkoff J, et al. Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment. Neuropsychiatry Dis Treat. 2005;1:311–27. Arciniegas DB, Anderson CA, Topkoff J, et al. Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment. Neuropsychiatry Dis Treat. 2005;1:311–27.
24.
go back to reference Carroll L, Cassidy J, Peloso P, et al. Prognosis for mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med 2004;(43 Suppl):84–105. Carroll L, Cassidy J, Peloso P, et al. Prognosis for mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med 2004;(43 Suppl):84–105.
25.
go back to reference McCrea M, Iverson GL, McAllister TW, et al. An integrated review of recovery aftermild traumatic brain injury (MTBI): implications for clinical management. Clin Neuropsychol. 2009;23:1368–90.CrossRefPubMed McCrea M, Iverson GL, McAllister TW, et al. An integrated review of recovery aftermild traumatic brain injury (MTBI): implications for clinical management. Clin Neuropsychol. 2009;23:1368–90.CrossRefPubMed
26.
go back to reference McLean S, Kirsch N, Tan-Schriner Ch, et al. Health status, not head injury, predicts concussion symptoms after minor injury. Am J Emerg Med. 2009;27:182–90.CrossRefPubMed McLean S, Kirsch N, Tan-Schriner Ch, et al. Health status, not head injury, predicts concussion symptoms after minor injury. Am J Emerg Med. 2009;27:182–90.CrossRefPubMed
27.
go back to reference Stulemeijer M, Vos P, Bleijenberg G, et al. Cognitive complaints after mild traumatic brain injury: things are not always what they seem. J Psychosom Res. 2007;63:637–45.CrossRefPubMed Stulemeijer M, Vos P, Bleijenberg G, et al. Cognitive complaints after mild traumatic brain injury: things are not always what they seem. J Psychosom Res. 2007;63:637–45.CrossRefPubMed
Metadata
Title
Post-concussive syndrome after mild head trauma: epidemiological features in Tunisia
Authors
O. Chakroun-Walha
I. Rejeb
M. Boujelben
K. Chtara
A. Mtibaa
H. Ksibi
A. Chaari
M. Bouaziz
N. Rekik
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2017
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-016-0656-7

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