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JAMA Psychiatry. 2014 Sep;71(9):1032-40. doi: 10.1001/jamapsychiatry.2014.666.

Association of symptoms following mild traumatic brain injury with posttraumatic stress disorder vs. postconcussion syndrome.

Author information

1
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Equipe Prévention et Prise en Charge des Traumatismes F-33000, Bordeaux, France2Université Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000, Bordeaux, France.
2
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Equipe Prévention et Prise en Charge des Traumatismes F-33000, Bordeaux, France2Université Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000, Bordeaux, France3CHU de B.
3
Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
4
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Equipe Prévention et Prise en Charge des Traumatismes F-33000, Bordeaux, France5CHU de Bordeaux, Pole d'Anesthésie Réanimation, F-33000, Bordeaux, France.
5
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Equipe Prévention et Prise en Charge des Traumatismes F-33000, Bordeaux, France6CHU de Bordeaux, Pole de Médecine, F-33000, Bordeaux, France.
6
Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark8Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto.

Abstract

IMPORTANCE:

A proportion of patients experience long-lasting symptoms following mild traumatic brain injury (MTBI). The postconcussion syndrome (PCS), included in the DSM-IV, has been proposed to describe this condition. Because these symptoms are subjective and common to other conditions, there is controversy whether PCS deserves to be identified as a diagnostic syndrome.

OBJECTIVE:

To assess whether persistent symptoms 3 months following head injury are specific to MTBI or whether they are better described as part of posttraumatic stress disorder (PTSD).

DESIGN, SETTING, AND PARTICIPANTS:

We conducted a prospective cohort study of injured patients recruited at the adult emergency department of the University Hospital of Bordeaux from December 4, 2007, to February 25, 2009.

MAIN OUTCOMES AND MEASURES:

At 3-month follow-up, we compared the prevalence and risk factors for PCS and PTSD. Multiple correspondence analyses were used to assess clustering of symptoms and their associations with the type of injury.

RESULTS:

We included 534 patients with head injury and 827 control patients with other nonhead injuries. Three months following the trauma, 21.2% of head-injured and 16.3% of nonhead-injured patients fulfilled the DSM-IV diagnosis of PCS; 8.8% of head-injured patients fulfilled the diagnostic criteria for PTSD compared with 2.2% of control patients. In multivariate analysis, MTBI was a predictor of PTSD (odds ratio, 4.47; 95% CI, 2.38-8.40) but not of PCS (odds ratio, 1.13; 95% CI, 0.82-1.55). Correspondence analysis suggested that symptoms considered part of PCS behave similarly to PTSD symptoms in the hyperarousal dimension. None of these 22 symptoms showed any pattern of clustering, and no clear proximity with head or nonhead injury status could be found.

CONCLUSIONS AND RELEVANCE:

Persistent subjective symptoms frequently reported 3 months after MTBI are not specific enough to be identified as a unique PCS and should be considered part of the hyperarousal dimension of PTSD.

PMID:
25029015
DOI:
10.1001/jamapsychiatry.2014.666
[Indexed for MEDLINE]

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