Factors Associated with Post-Concussion Syndrome in Patients with Mild Traumatic Brain Injury After Discharging from an Emergency Department

Authors

  • Noppanan Wongchai Srisavarindhira Thai Red Cross Institute of Nursing
  • Rotsukon Varitsakul Srisavarindhira Thai Red Cross Institute of Nursing
  • Nopmanee Tantivesruangdet สถาบันการพยาบาลศรีสวรินทิรา สภากาชาดไทย

Keywords:

Post-Concussion Syndrome, Mild traumatic brain injury, Emergency Room

Abstract

Post-Concussion Syndrome (PCS) occurs more often in patients with mild traumatic brain injury, leading to the incidence of emergency room (ER) re-visits. This descriptive correlational study aimed to investigate PCS in patients with mild traumatic brain injury after being discharged from an ER and to examine correlational factors of PCS including age, co-morbid severity, injury severity, anxiety, and social support. The sample were 107 patients with mild traumatic brain injury who visited and were discharged from the emergency room within one week at a governmental hospital (super-tertiary level) and a private hospital (tertiary level). The Rivermead Post-Concussion Symptoms Questionnaire, the State-Trait Anxiety Inventory [STAI Form Y-1], the Social Support Questionnaire, the Charlson Comorbidity Index, and the Injury Severity Score were used to collect data. The reliability of the question- naires was tested. The Cronbach’s alpha coefficients of the first-three questionnaires were .90, .75 and .88, respectively. Data were analyzed using descriptive statistics and Pearson’s product moment correlation.

The results showed that the three symptoms occurring most in PCS were headache (56.1%), sleep disturbance (52.8%), and fatigue (48.6%). Most had five to eight symptoms (33.6%). Age and injury severity were positively correlated at a low level with post-concussion syndrome at a statistically significant level (r = .22 and r = .22, respectively, p <.05).

Emergency nurses can use this study’s results to provide care for patients with mild traumatic brain injury in the first week post-concussion and to develop nursing interventions to minimize the first week’s PCS severity.

References

Arango-Lasprilla, J. C., Zeldovich, M., Olabarrieta-Landa, L., Forslund, M. V., Núñez-Fernández, S., von Steinbuechel, N., & Investigators. (2020). Early predictors of employment status one year post injury in individuals with traumatic brain injury in Europe. Journal of Clinical Medicine, 9(6). doi:10.3390/jcm9062007

Babcock, L., Byczkowski, T., Wade, S. L., Ho, M., Mookerjee, S., & Bazarian, J. J. (2013). Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the Emergency Department. The Journal of the American Medical Association Pediatr, 167(2), 156-161. doi:10.1001/jamapediatrics.2013.434

Baker, S. P., O'Neill, B., Haddon, W., Jr., & Long, W. B. (1974). The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. The Journal of Trauma and Acute Care Surgery, 14(3), 187-196.

Bazarian, J. J., Donnelly, K., Peterson, D. R., Warner, G. C., Zhu, T., & Zhong, J. (2013). The relation between posttraumatic stress disorder and mild traumatic brain injury acquired during operations enduring freedom and iraqi freedom. The Journal of Head Trauma Rehabilitation, 28(1), 1-12. doi:10.1097/HTR.0b013e318256d3d3

Bergman, K., & Bay, E. (2010). Mild traumatic brain injury concussion: A review for ed nurses. The Journal of Emergency Nursing, 36(3), 221-230. doi:10.1016/j.jen.2009.07.001

Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO Collaborating Centre Task Force on mild traumatic brain injury. Journal of Rehabilitation Medicine,43(Suppl), 113-125. doi:10.1080/16501960410023877

Chatimah, C., Pratiwi, I. D., & Al Husna, C. H. (2021). Correlation between trauma and injury severity score and prognosis in patients with trauma. Journal of Taibah University Medical Sciences, 16(6), 807-811.

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373-383. doi:10.1016/0021-9681(87)90171-8

Cnossen, M. C., van der Naalt, J., Spikman, J. M., Nieboer, D., Yue, J. K., Winkler, E. A., & Lingsma, H. F. (2018). Prediction of persistent post-concussion symptoms after mild traumatic brain injury. Journal of Neurotrauma, 35(22), 2691-2698.

Department of Disease Control (2020). Annual report 2020 bureau of non-communicable diseases. Retrieved from https://ddc.moph.go.th/uploads/publish/.pdf. (in Thai)

Fried, E., Balla, U., Catalogna, M., Kozer, E., Oren-Amit, A., Hadanny, A., & Efrati, S. (2022). Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly underdiagnosed. Scientific Reports, 12(1), 4364. Retrieved from https://doi.org/10.1038/s41598-022-08302-0

Fuller, G. W., Evans, R., Preston, L., Woods, H. B., & Mason, S. (2019). Should adults with mild head injury who are receiving direct oral anticoagulants undergo computed tomography scanning? A systematic review. Annals of Emergency Medicine, 73(1), 66-75. doi:10.1016/j.annemergmed.2018.07.020

Ganti, L., Conroy, L. M., Bodhit, A., Daneshvar, Y., Patel, P. S., Ayala, S., & Lottenberg, L. L. (2015). Understanding why patients return to the emergency department after mild traumatic brain injury within 72 hours. Western Journal of Emergency Medicine, 16(3), 481-485. doi:10.5811/westjem.2015.2.23546

Glenn, M. B., & Herman, S. D. (2020). Chapter 148-Post-concussion Symptoms. In W. R. Frontera, J. K. Silver, & T. D. Rizzo (Eds.), Essentials of physical medicine and rehabilitation (4th ed., pp. 841-848). New York: Elsevier.

Hickey, J. V., & Strayer, A. L. (Eds.). (2019). The clinical practice of neurological and neurosurgical nursing (8th ed.). Wolters Kluwer.

Injury Surveillance System Development Team (2020). Manual data collection provincial injury surveilance. Bangkok: Ministry of Health.

Isaacs, B., & Kennie, A. T. (1973). The set test as an aid to the detection of dementia in old people. The British Journal of Psychiatry, 123(575), 467-470. doi:10.1192/bjp.123.4.467

Kaenphet, S. (2014). The post-concussion symptom experiences, symptom management and quality of life in clients with mild traumatic brain injury in the upper suthern region. (Master's thesis), Prince of Songkla University, Thailand. (in Thai)

Kaufman, D. M., Geyer, H. L., & Milstein, M. J. (2017). Traumatic brain injury. In D. M. Kaufman, H. L. Geyer, & M. J. Milstein (Eds.), Kaufman's clinical neurology for psychiatrists (8th ed., pp. 519-535). Elsevier

Kesarin Theankaew , Niphawan Samartkit , & Khemaradee Masingboon (2019). Relationships between headache, sleep disturbance, fatigue and quality of life in patients with mild traumatic brain injury at 3 months after the trauma. Journal of Nursing and Health Care, 37(4), 157 - 166. (in Thai)

King, N. S., Crawford, S., Wenden, F. J., Moss, N. E., & Wade, D. T. (1995). The rivermead post concussion symptoms questionnaire: A measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242(9), 587-592.

Kinklaykan, K., & Jitpanya, C. ( 2019). Relationships among pain, anxiety, social support, and post concussive syndromes. Chula Med Bull, 1(5), 439-449. (in Thai)

Leddy, J. J., Sandhu, H., Sodhi, V., Baker, J. G., & Willer, B. (2012). Rehabilitation of concussion and post-concussion syndrome. Sports Health, 4(2), 147-154.

Lenz, E. R., Pugh, L. C., Milligan, R. A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27. doi.org/10.1097/00012272-199703000-00003

Levin, H. S., Temkin, N. R., Barber, J., Nelson, L. D., Robertson, C., Brennan, J., & Zafonte, R. (2021). Association of sex and age with mild traumatic brain injury-related symptoms: A TRACK-TBI Study. JAMA Netw Open, 4(4), e213046.

Lundin, A., de Boussard, C., Edman, G., & Borg, J. (2006). Symptoms and disability until 3 months after mild TBI. Brain Injury, 20(8), 799–806.

Røe, C., Sveen, U., Alvsåker, K., & Bautz-Holter, E. (2009). Post-concussion symptoms after mild traumatic brain injury: Influence of demographic factors and injury severity in a 1-year cohort study. Disabil Rehabil, 31(15), 1235-1243.

World Health Organization. (2019). World health statistics 2019: Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization.

Phuenpathom, N. (2019). Clinical practice guidelines for traumatic brain injury (Vol. 1). Bangkok: Prosperous Plus. (in Thai)

Ponsford, J., Cameron, P., Fitzgerald, M., Grant, M., Mikocka-Walus, A., & Schönberger, M. (2012). Predictors of postconcussive symptoms 3 months after mild traumatic brain injury. Neuropsychology, 26(3), 304-313. doi:10.1037/a0027888

Pratum, J., & Kitbanyonglert, S. (2018). The Effects of implementing the clinical nursing guidelines for the assessment of patients with mild traumatic brain injury in the emergency department, Vachira Phuket Hospital. Medical Journal, 32(4), 1431 - 1450. (in Thai)

Røe, C., Sveen, U., Alvsåker, K., & Bautz-Holter, E. (2009). Post-concussion symptoms after mild traumatic brain injury: Influence of demographic factors and injury severity in a 1-year cohort study. Disability and Rehabilitation, 31(15), 1235-1243.

Schaefer, C., Coyne, J. C., & Lazarus, R. S. (1981). The health-related functions of social support. Journal of Behavioral Medicine, 4(4), 381-406. doi:10.1007/bf00846149

Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

Thapinta, D. (1991). Reduction of anxiety of staff nurses working with aids patients through cognitive reconstructuring and mindfulness training. (Doctoral Dissertation), Chulalongkorn University, Thailand. (in Thai)

Utaisang, A., & Pearkao, C. (2016). Factors associated with severity level of post-concussion syndrome in patients with mild traumatic brain injury. The National and International Graduate Research Conference, 668-677. (in Thai)

Wardlaw, C., Hicks, A. J., Sherer, M., & Ponsford, J. L. (2018). Psychological resilience is associated with participation outcomes following mild to severe traumatic brain injury. Frontiers in Neurology, 9, 563.

Whelan, A. (2017). Post-concussion syndrome: Pathophysiology and treatment. Retrieved from https://www.researchgate.net/publication/319143679_Post-Concussion_Syndrome_Pathophysiology_and_Treatment

Willer, B. S., & Leddy, J. J. (2006). Management of concussion and post-concussion syndrome. Current Treatment Options in Neurology, 8, 415-426.

World Health Organization. (2019). World health statistics 2019: Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization.

Yue, J. K., Levin, H. S., Suen, C. G., Morrissey, M. R., Runyon, S. J., Winkler, E. A., … TRACK-TBI Investigators (2019). Age and sex-mediated differences in six-month outcomes after mild traumatic brain injury in young adults: A TRACK-TBI study. Neurological Research, 41(7), 609-623.

Yuksen, C., Sittichanbuncha, Y., Kreethep, W., Chantawong, T., Suk-um, P., Meemongkol, T., & Yaithet, J. (2017). Validity of MTBI score to predict intracranial hemorrhage in mild traumatic brain injury. Bangkok: Mahidol University. (in Thai)

Zahniser, E., Nelson, L. D., Dikmen, S. S., Machamer, J. E., Stein, M. B., Yuh, E., … TRACK-TBI Investigators. (2019). The temporal relationship of mental health problems and functional limitations following mTBI: A TRACK-TBI and TED study. Journal of Neurotrauma, 36(11), 1786-1793. doi.org/10.1089/n

Downloads

Published

2022-06-30

How to Cite

Wongchai, N., Varitsakul, R., & Tantivesruangdet, N. (2022). Factors Associated with Post-Concussion Syndrome in Patients with Mild Traumatic Brain Injury After Discharging from an Emergency Department. Nursing Journal CMU, 49(2), 252–269. Retrieved from https://he02.tci-thaijo.org/index.php/cmunursing/article/view/256252

Issue

Section

Research Article