Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them? A Population-Based 1-Year Inception Cohort Study

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SOURCE:   Arch Phys Med Rehab 2014 (Mar); 95 (3 Sup): S286–294

Jan Hartvigsen, PhD, Eleanor Boyle, PhD, J. David Cassidy, PhD, DrMedSc, Linda J. Carroll, PhD

Institute of Sports Science and Clinical Biomechanics,
University of Southern Denmark, Odense, Denmark;
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.

OBJECTIVE:   To describe the 1-year course of symptoms following mild traumatic brain injury (MTBI) sustained in a motor vehicle collision as well as patterns of care-seeking.

DESIGN:   One-year follow-up of a population-based inception cohort.

SETTING:   The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.

PARTICIPANTS:   Persons (N=1716) sustaining an MTBI during a car collision between November 1997 and December 1999.

INTERVENTIONS:   Not applicable.

MAIN OUTCOME MEASURES:   We report the prevalence of sleep disturbances, tiredness, dizziness, forgetfulness, vision problems, hearing problems, headache, neck pain, mid back pain, and low back pain at 6 weeks and 3, 6, 9, and 12 months postcollision. At the same time points, we report self-reported care-seeking from registered health care professionals.

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RESULTS:   A total of 1716 adults suffered MTBI after a motor vehicle collision over the 2-year inception period. Six weeks after the collision, 75% reported having more than 3 symptoms and 30% had clinically significant pain in more than 3 body sites. Over time, the prevalence of symptoms and pain decreased but they were still common after 1 year. Almost all participants sought care for their symptoms at all time points, most commonly from a physician. Care-seeking from physiotherapists, chiropractors, and massage therapists was also very common, and most participants sought care from 2 or 3 providers at all follow-up points.

CONCLUSIONS:   Up to 1 year after sustaining an MTBI during a motor vehicle collision, multiple symptoms and pain in several anatomical sites are common. Care-seeking from multiple providers continues throughout the first year postinjury.

KEYWORDS:   Brain concussion; Cohort studies; Health care seeking behaviour; Rehabilitation


From the FULL TEXT Article:


While the true incidence of traumatic brain injury (TBI) and concussion is not known, it is estimated that as many as 600 of every 100,000 Americans are affected every year, [1] resulting in approximately 1.4 million visits to emergency departments yearly. [2] There is evidence that the incidence of TBI is increasing, especially during sports activities, possibly reflecting both true increase and increased reporting. [3, 4]

TBI severity is usually categorized into mild, moderate, or severe, most often on the basis of the Glasgow Coma Scale score, [5] with the most common being mild traumatic brain injury (MTBI), also commonly known as concussion. [2] Symptoms after MTBI vary but may include headache, blurred vision, confusion, dizziness, memory problems, fatigue, and sleep difficulties to varying degrees. [6] Imaging of the brain in persons having suffered an MTBI is usually normal. [7] Most patients with MTBI recover within the first year even though a significant minority continues to report symptoms. [8] The International Collaboration on MTBI Prognosis reviewed and critically appraised the literature relating to subjective symptoms after adult MTBI and found that although self-reported symptoms such as headache and fatigue are common even after 1 year, they are not specific to MTBI but are equally present in those with other nonhead injuries. [9] For instance, Lannsjo et al [10] reported that 44% of the persons presenting to an emergency department after MTBI still had 1 or more symptoms after 3 months, most commonly fatigue, headache, and dizziness. However, it is unclear what the source population was in this and other studies, and they did not collect data on a range of symptoms such as neck and back pain. [10]

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