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Objective: After a concussion, 1 in 3 patients report persistent symptoms and experience long-term consequences interfering with daily functioning, known as persistent concussion symptoms (PCS). Evidence suggests PCS is (partly) maintained by anxious thoughts about brain functioning, recovery, and experienced symptoms, leading to avoidance behaviors, which may prevent patients from meeting life demands. We aimed to investigate the efficacy of a newly developed intensive exposure intervention for individuals with PCS after concussion aimed to tackle avoidance behavior. Setting: Participants took part in the intervention at the Maastricht University faculty. Participants: Four participants who experienced PCS after concussion partook in the exploratory study. Participants’ age ranged between 20 and 32 (mean = 26.5, SD = 5.9) years, with an average length of time after the concussion of 9.8 months. Design: A concurrent multiple-baseline single-case design was conducted. The baseline period (A phase) length was randomly determined across participants (3, 4, 5, or 6 weeks). The exposure intervention (B phase) was conducted by psychologists over a 4-week period and consisted of 3 stages: exploration (2 sessions), active exposure (12 sessions conducted over 1 week), and 2 booster sessions. Main Measures: Participants answered daily questions on a visual analog scale related to symptom experience, satisfaction with daily functioning, and degree of avoidance of feared activities. Additional outcomes included symptom severity, catastrophizing, fear of mental activity, anxiety, depression, and societal participation. Results: Tau-U yielded significant effects (P < .05) for all participants on all measures when comparing baseline and intervention phases. The pooled standardized mean difference was high for all measures (symptom experience = 0.93, satisfaction of daily functioning = 1.86, and activity avoidance = −2.05). Conclusions: The results show efficacy of the newly developed intensive exposure treatment for PCS after concussion, which is based on the fear avoidance model. Replication in a larger heterogeneous sample is warranted and needed. [ABSTRACT FROM AUTHOR]

Objective: It has been suggested that sport-related concussion (SRC) occurs more commonly on natural grass compared with artificial turf in contact sports. As playing surface is a potentially modifiable risk factor, this study sought to identify differences in symptoms following SRC on these 2 surfaces in a sample of young American football players. Design: Prospective. Setting: Part of the multi-institutional North Texas Concussion Registry (ConTex) research project. Participants: Ten-year-old to 24-year-old male American football players (n = 62) who had sustained a helmet-to-ground SRC and presented to a specialty concussion clinic within 14 days of injury. Independent variables: Helmeted impact with grass (n = 33) or artificial turf (n = 29). Main outcome measures: Severity and number of symptoms endorsed on the Sport Concussion Assessment Tool 5th Edition (SCAT5) Symptom Evaluation at the time of initial clinical evaluation. Results: Both groups were similar in mean time since injury, concussion history, and history of headache, but the artificial turf group was slightly older, with a mean age of 14.6 versus 13.6 years ( P = 0.039). Athletes who sustained a SRC on grass reported significantly higher mean total symptom severity scores (26.6 vs 11.6, P = 0.005) and total number of symptoms (10.3 vs 5.9, P = 0.006) compared with those who were injured on artificial turf. Conclusions: This may be the first study to examine postconcussive symptoms after SRC as they relate to playing surface. This small sample of young American football players reported higher symptom severity scores and higher total number of symptoms after SRC on natural grass compared with artificial turf. [ABSTRACT FROM AUTHOR]

Objective: To identify both shared and unique groups of posttraumatic stress and postconcussive symptoms using bifactor analysis. Setting: Two large military outpatient traumatic brain injury (TBI) rehabilitation clinics in the Southwestern United States. Participants: A sample of 1476 Active Duty Service Members seeking treatment for a mild TBI sustained more than 30 days previously, without history of moderate or severe TBI, who completed measures of postconcussive and posttraumatic stress symptoms assessed at clinic intake. Design: Observational, correlational study with data taken from an institutional review board-approved clinical registry study. Main Measures: Neurobehavioral Symptom Inventory (NSI) and Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-V) (PCL-5). Concurrent measures were Patient Health Questionnaire (PHQ-8), Pittsburgh Sleep Quality Index (PSQI), and Headache Impact Test (HIT-6). Results: Results identified a bifactor model demonstrating unique posttraumatic stress, depressive, cognitive, and neurological/somatic symptom groups that were still evident after accounting for a universal factor representing general distress. These symptom groups were differentially related to concurrently measured clinical outcomes. Conclusion: Use of a bifactor structure may help derive clinically useful signals from self-reported symptoms among Active Duty Service Members seeking outpatient treatment for mild TBI. [ABSTRACT FROM AUTHOR]

Objective: Female athletes may be more likely to sustain a concussion and may vary in symptom presentation and neurocognitive impairments as compared with males. Scientific literature is limited by subjective assessments and underproportioned representation of women—the scope and etiology of sex-based differences are unknown. This study investigates sex-based differences in sports concussion assessments among college varsity athletes. Design and Setting: Retrospective study of an institution's athletic head injury database. Participants: Acute postinjury and baseline data from 111 college athletes sustaining concussions between 2016 and 2018, diagnosed by a concussion specialist physician. Main Outcome Measures: Concussion assessments examined included the Sports Concussion Assessment Tool (SCAT5) and Vestibular Oculomotor Screening (VOMS) performed within 3 days (24-72 hours) of injury. Results: No significant difference by sex was observed in the SCAT5 total symptom evaluation scores or severity scores, Standardized Assessment of Concussion, or Balance Error Scoring System (P >.05) within 3 days of head injury. Females did report more "pressure in the head" severity scores from baseline to postconcussion (2.7 ± 1.5 increased symptomatology in females vs 1.8 ± 1.3 increase in males, P =.007). The VOMS test resulted in significant sex differences in smooth pursuit [0.6 ± 1.4 increase in females (P <.001) vs 0.2 ± 0.6 increase in males (P =.364)], horizontal saccades [0.6 ± 1.2 increase in females (P <.001) vs 0.2 ± 0.5 increase in males (P =.149)], and vertical saccades [0.9 ± 1.9 increase in females (P <.001) vs 0.3 ± 0.7 increase in males (P =.206)]. Conclusion: Our study did not show sex-based differences in baseline or acute postconcussive symptom reporting in most concussion assessment parameters, challenging previous research suggesting that females report more symptoms than males. Females did have significant differences in symptom provocation using the VOMS. [ABSTRACT FROM AUTHOR]

Objective: Understanding factors contributing to neurobehavioral symptom burden among intimate partner violence (IPV) survivors has important implications for prevention, screening, and intervention in this vulnerable population. This study aimed to (1) identify the relationship between childhood trauma and neurobehavioral symptoms among a shelter- and community-based sample of IPV survivors, including investigating the mediating role of posttraumatic stress symptoms and alexithymia in this relationship; (2) assess the association between IPV-related brain injury (BI) severity and neurobehavioral symptoms; and (3) assesses whether physical, emotional, or cognitive domains of neurobehavioral symptom burden show differential associations with childhood trauma or IPV-related BI. Setting: Community sites serving women who had experienced IPV such as domestic violence shelters and transitional housing sites. Participants: Women survivors of IPV with and without BI (n = 99), aged 18 to 54 years. Design: Retrospective, cross-sectional study design. Measures: The following self-reported questionnaires were used: Rivermead Post Concussion Questionnaire (RPQ); Childhood Trauma Questionnaire (CTQ); a modified version of the Conflict Tactics Scale; Brain Injury Severity Assessment (BISA); Clinician-Administered PTSD Scale for DSM IV ; and Toronto Alexithymia Scale. The final multivariate regression model assessed the association between childhood abuse, BI severity, and neurobehavioral symptoms (as measured by the RPQ) adjusting for age, educational attainment, and abuse in the past year. We created separate models with total neurobehavioral symptom score as an outcome, as well as somatic, emotional, and cognitive symptom scores. We used structural equation modeling to assess whether posttraumatic stress and alexithymia mediated the effect of childhood trauma and neurobehavioral symptoms. Results: Childhood trauma was associated with higher levels (P <.01) of overall neurobehavioral symptom burden in women independent of BI and specifically associated with RPQ Emotional and Somatic subscale symptoms (P ≤.05). BI was positively associated with somatic symptoms in the full sample and cognitive neurobehavioral symptoms in the sample of women with IPV-related BI (P <.05) independent of childhood trauma. Posttraumatic stress symptoms, but not alexithymia, partially mediated the effect of childhood trauma effect on neurobehavioral symptoms. Conclusion: Childhood trauma and BI should not be overlooked as part of efforts to meet the needs of IPV survivors who may experience a range of emotional, somatic, and cognitive symptoms. [ABSTRACT FROM AUTHOR]

Objective: To describe rates of mild traumatic brain injury (mTBI) with and without concurrent posttraumatic stress disorder a sample of former and current military personnel, and to compare the factor structure of the Neurobehavioral Symptom Inventory (NSI) based on whether participants sustained mTBI with and without a positive posttraumatic stress disorder (PTSD) screen. Setting: Participants recruited and tested at 7 Veterans Affairs (VA) sites and 1 military training facility as part of a national, longitudinal study of mental health, physical, and cognitive outcomes among veterans and service members. Participants: Total of 1540 former and current military personnel with a history of combat exposure. Design: Cross-sectional analysis of observational data, including confirmatory factor analysis. Main Measures: NSI and PTSD Checklist for DSM-5 (PCL-5). Results: Most participants (81.5%) had a history of mTBI and almost half of these screened positive for PTSD (40.5%); only 23.9% of participants without a history of mTBI screened positive for PTSD. Participants with a history of mTBI reported higher elevations of NSI and PCL-5 symptoms compared with those without a history of mTBI. Confirmatory factor analyses of the NSI demonstrated good model fit using a 4-factor structure (somatosensory, affective, cognitive, and vestibular symptoms) among groups of participants both with and without a history of mTBI. Conclusion: Symptoms of mTBI and PTSD are strongly associated with each other among veterans and service members with a history of combat exposure. The 4-factor NSI structure is supported among participants with and without a history of mTBI. These findings suggest the potential benefit of a holistic approach to evaluation and treatment of veterans and service members with concurrent and elevated postconcussive and posttraumatic stress symptoms. [ABSTRACT FROM AUTHOR]

Objective: To describe changes in the prevalence and clinical correlates of noise sensitivity (NS) in mild traumatic brain injury (mTBI) across a 12-month period and to determine whether NS at an early stage of recovery has predictive value for later postconcussive symptoms. Setting: A mixed urban and rural region of New Zealand. Participants: Data for 341 adults (201 males, 140 females; age range from 16 to 91 years) were extracted from a 1-year TBI incidence, and outcomes study was conducted in New Zealand. Design: Secondary analysis of data from a community-based, longitudinal population study of an mTBI incidence cohort collected within 1 week of injury (baseline) and at 1, 6, and 12 months postinjury. Main Measures: Measures at baseline (within 2 weeks of the injury) and 1, 6, and 12 months included the Rivermead Post-concussion Symptoms Questionnaire and its NS item, the Hospital Depression and Anxiety Scale, and the computerized CNS-Vital Signs neurocognitive test. Results: NS progressively declined postinjury, from 45% at baseline to 28% at 12 months. In turn, NS showed itself as a significant predictor of future postconcussive symptoms. Conclusion: Taken together with previous research, the findings of the current study indicate that NS may have clinical utility in flagging vulnerability to persistent postconcussive symptoms. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for suicidal ideation (SI) following mild traumatic brain injury (mTBI). Setting: Eleven US level 1 trauma centers. Participants: A total of 1158 emergency department patients with mTBI (Glasgow Coma Scale score = 13-15) enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. Design: Prospective observational study; weights-adjusted multivariable logistic regression models (n's = 727-883) estimated associations of baseline factors and post-TBI symptoms with SI at 2 weeks and 3, 6, and 12 months postinjury. Main Measures: Patient Health Questionnaire, Rivermead Post-Concussion Symptoms Questionnaire. Results: Preinjury psychiatric history predicted SI at all follow-ups (adjusted odds ratios [AORs] = 2.26-6.33, Pvalues <.05) and history of prior TBI predicted SI at 2 weeks (AOR = 2.36, 95% confidence interval [CI] = 1.16-4.81, P = .018), 3 months (AOR = 2.62, 95% CI = 1.33-5.16, P = .005), and 6 months postinjury (AOR = 2.54, 95% CI = 1.19-5.42, P = .016). Adjusting for these baseline factors, post-TBI symptoms were strongly associated with SI at concurrent (AORs = 1.91-2.88 per standard deviation unit increase in Rivermead Post-Concussion Symptoms Questionnaire score; P values <.0005) and subsequent follow-up visits (AORs = 1.68-2.53; P values <.005). Most of the associations between post-TBI symptoms and SI were statistically explained by co-occurring depression. Conclusion: Screening for psychiatric and prior TBI history may help identify patients at risk for SI following mTBI. Awareness of the strong associations of post-TBI symptoms with SI may facilitate interventions to prevent suicide-related outcomes in patients with mTBI. [ABSTRACT FROM AUTHOR]

Objectives: To determine the proportion of children with postconcussive symptoms (PCSs) and to explore the influence of noninjury and injury factors on parents' PCS report at 3 months postinjury. Design: A cross-sectional analysis of the 3-month postinjury data from a larger, prospective, longitudinal study. Methods: Parents and their child aged 2 to 12 years who presented at the emergency department with either a mild traumatic brain injury (mTBI) or a superficial injury to the head (SIH) were recruited. Parents reported their child's symptoms at the time of injury and at 3 months postinjury. Child, family/parent, and injury characteristics were considered as potential predictors. Logistic regression was conducted to determine which factors increase the likelihood of parents' PCS report. Results: At 3 months postinjury, 30% and 13% of children in the mTBI and SIH groups exhibited 1 or more symptoms, respectively. On the other hand, 18% (mTBI) and 8% (SIH) continued to have ongoing problems when 2 or more symptoms were considered at follow-up. The final model, which included child's sex, injury group, number of symptoms at the time of injury, and parental stress, had a significant predictive utility in determining parents' report of 1 or more symptoms at follow-up. Only parental stress continued to be a significant predictor when considering 2 or more symptoms at 3 months postinjury. Conclusions: Children with mTBI have worse outcomes than children with SIH at follow-up, with parents more likely to report 1 or more ongoing symptoms if their children had an mTBI. Postinjury assessment of parental stress and ongoing symptom monitoring in young children with mTBI will allow for timely provision of support for the family. [ABSTRACT FROM AUTHOR]

Objective: To understand the relationships between traumatic brain injury (TBI), blood biomarkers, and symptoms of posttraumatic stress disorder (PTSD), depression, and postconcussive syndrome symptoms. Design: Cross-sectional cohort study using multivariate analyses. Participants: One hundred nine military personnel and veterans, both with and without a history of TBI. Main Measures: PTSD Checklist-Civilian Version (PCL-C); Neurobehavioral Symptom Inventory (NSI); Ohio State University TBI Identification Method; Patient Health Questionnaire-9 (PHQ-9); Simoa-measured concentrations of tau, amyloid-beta (Aβ) 40, Aβ42, and neurofilament light (NFL). Results: Controlling for age, sex, time since last injury (TSLI), and antianxiety/depression medication use, NFL was trending toward being significantly elevated in participants who had sustained 3 or more TBIs compared with those who had sustained 1 or 2 TBIs. Within the TBI group, partial correlations that controlled for age, sex, TSLI, and antianxiety/depression medication use showed that tau concentrations were significantly correlated with greater symptom severity, as measured with the NSI, PCL, and PHQ-9. Conclusions: Elevations in tau are associated with symptom severity after TBI, while NFL levels are elevated in those with a history of repetitive TBIs and in military personnel and veterans. This study shows the utility of measuring biomarkers chronically postinjury. Furthermore, there is a critical need for studies of biomarkers longitudinally following TBI. [ABSTRACT FROM AUTHOR]

Objective: This study compares combat-related mild traumatic brain injury (mTBI) to non-combat-related mTBI in rates of posttraumatic stress disorder (PTSD) and depression after injury, severity of postconcussive symptoms (PCSs), and attribution of those symptoms to mTBI versus PTSD. Participants: A total of 371 active duty service members (SMs) with documented history of mTBI, divided into combat and non-combat-related cohorts. Design: Retrospective cohort study. Main Measures: Diagnoses of PTSD and depression based on medical record review and self-report. PCSs measured using Neurobehavioral Symptom Index. Attribution of symptoms based on a rating scale asking how much mTBI, PTSD, depression, deployment, or readjustment stress contributed to current symptoms. Results: Prevalence of PTSD was significantly higher after a combat-related mTBI, compared with a noncombat mTBI (P = .001). Prevalence of depression did not differ between the 2 groups. PCSs were high in both combat and noncombat mTBIs, with no statistical difference between groups. SMs with PTSD reported higher PCS, regardless of combat status. SMs without PTSD attributed symptoms mainly to mTBI, whereas SMs with PTSD, regardless of combat status, were much more likely to attribute symptoms to PTSD, depression, and deployment/readjustment stress. Conclusions: This research contributes to our understanding of the complex interplay between mTBI and PTSD in both combat and noncombat injuries within the military population and the importance of addressing both simultaneously. [ABSTRACT FROM AUTHOR]

Objective: Prior work suggests that younger athletes may be more vulnerable to postconcussive syndrome. We investigated measures of clinical outcome and quantitative volumetric imaging in 10- to 14-year-old adolescent athletes to better understand the impact of concussion on this younger population. Setting: Outpatient clinics. Participants: Ten- to 14-year-old symptomatic pediatric sports concussion patients and typically developing active controls. Design: Prospective, observational multiclinic study. Main Measures: Demographics, magnetic resonance imaging, clinical assessments (neurocognitive function, postconcussive symptoms, mental health symptoms, quality of life). Results: Neuropsychological performance was comparable between groups while symptoms of mental health were discriminating and comprised the top regression model describing factors related to overall health behavior impairment. Concussion patients had smaller total brain volume as well as total intracranial volume in comparison with controls even though there was no difference on measures of natural development (age, height, weight, education, gender, and handedness). Conclusions: Findings indicate that 10- to 14-year-old concussion patients symptomatic at 1 month more likely exhibit mental health symptoms impairing health behavior than cognitive dysfunction. There may be a vulnerability for those with smaller brain volumes at the time of the exposure. The study provides new data to support further investigation into risk factors for prolonged symptoms in this younger athlete population. [ABSTRACT FROM AUTHOR]

Objective: This study examined changes in postconcussive symptoms (PCS) over the acute postinjury recovery period, focusing on how daily PCSs differ between mild traumatic brain injury (mTBI) and other injury types. Setting: An urban emergency department (ED) in Western Pennsylvania. Subjects: A total of 108 adult patients with trauma being discharged from the ED were recruited and grouped by injury type: mild TBI (mTBI; n = 39), head injury without mTBI (HI: n = 16), and non-head-injured trauma controls (TCs: n = 53). Main Measures: Subjects completed a baseline assessment and an experience sampling method (ESM) protocol for 14 consecutive days postinjury: outcomes were daily reports of headaches, anxiety, and concentration difficulties. Results: Controlling for confounders, multilevel modeling revealed greater odds of headache and concentration difficulties on day 1 postinjury among the HI and mTBI groups (vs TCs). These odds decreased over time, with greater reductions for the HI and mTBI groups compared with TCs. By day 14, there were no group differences in PCS. In addition, only the HI group reported higher initial levels of anxiety and a steeper slope relative to TCs. Conclusion: Patients with HI, regardless of whether they meet the American Congress of Rehabilitation Medicines definition of mTBI, have higher odds of typical PCS immediately postinjury, but faster rates of recovery than TCs. ESM can improve understanding the dynamic nature of postinjury PCS. [ABSTRACT FROM AUTHOR]

Objectives: To examine the frequency and nature of postconcussive symptoms (PCSs) and behavioral outcomes in young children following mild traumatic brain injury (mTBI) or concussion. Setting: Emergency department. Participants: Children aged 2 to 12 years presenting with either a concussion or minor bodily injury (control). Outcome Measurement: Parent ratings of PCS were obtained within 72 hours of injury, at 1 week, and 1, 2, and 3 months postinjury using a comprehensive PCS checklist. Preinjury behavior was examined at baseline using the Clinical Assessment of Behavior, which was readministered 1 and 3 months postinjury. Results: PCS burden following mTBI peaked in the acute phase postinjury but reduced significantly from 1 week to 1 month postinjury. Parents of children with mTBI reported more persistent PCSs up to 3 months postinjury than trauma controls, characterized mostly by behavioral and sleep-related symptoms. Subtle increases in problematic behaviors were observed from baseline (preinjury) to 1 month postinjury and persisted at 3 months postinjury; however, scores were not classified as clinically "at risk." Conclusions: A significant minority of young children experienced persistent PCS and problematic behavior following mTBI. Care must be taken when assessing PCS in younger children as method of PCS assessment may influence parental reporting. [ABSTRACT FROM AUTHOR]

Objective: To investigate the rates of negative outcomes associated with all severities of traumatic brain injury (TBI), treated in all settings or not treated at all, in comparison to the general population. Participants: Coloradoans without injury, with injury but no TBI, with mild TBI but no loss of consciousness (LOC), mild TBI with LOC,moderate TBI, or severe TBI. Design: Statewide population-based survey. Main measures: Computer-assisted,modified Ohio State University TBI Identification Method; Behavioral Risk Factor Surveillance System and National Health Interview Survey questions; Satisfaction with Life Scale; and postconcussive symptoms. Results: Up to 42.5% of participants reported a lifetime history of at least 1 TBI. Multiple negative outcomes were found to increase in prevalence in a stepwise fashion in association with greater TBI severity, with the clearest patterns observed for disability, poor life satisfaction, and impaired memory. Conclusions: Traumatic brain injury was found to be associated with disability and other negative outcomes in a general population survey. This study does not allow us to examine the proximate causes of disability, but it suggests that TBI may serve to both cause disability directly and exacerbate the influence of other etiologies. These relations should be examined in subsequent studies. [ABSTRACT FROM AUTHOR]

Objective: To explore the taxonomy of combat-related mild traumatic brain injury (mTBI) based on symptom patterns. Participants: Up to 1341 military personnel who experienced a combat-related mTBI within 2 years of evaluation. Measures: Neurobehavioral Symptom Inventory and PTSD Checklist-Civilian Version (PCL-C). Results: Cluster analysis revealed the following 4 subtypes: primarily psychiatric (posttraumatic stress disorder) group, a cognitive group, a mixed symptom group, and a good recovery group. The posttraumatic stress disorder cluster (21.9% of the sample) reported symptoms related to hyperarousal and dissociation/depression with few complaints related to cognition or headaches. The cognitive group (21.5% of the sample) had primarily cognitive and headache complaints with few mood symptoms. The mixed profile cluster included 18.6% of the sample and was characterized by a combination of mood complaints (hyperarousal and dissociation/depression), cognitive complaints, and headaches. The largest cluster (37.8% of the sample) had an overall low symptom profile and was labeled the "good recovery" group. Conclusions: The results support a unique taxonomy for combat-related mTBI. The clinical differences among these subtypes indicate a need for unique treatment resources and programs. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between postconcussive symptoms and quality of life (QOL) in Veterans with mild to moderate traumatic brain injury (TBI). Methods: Sixty-one Operation Enduring Freedom/Operation Iraqi Freedom/Persian Gulf War Veterans with a history of mild or moderate TBI, more than 6 months postinjury, and 21 demographically matched Veteran controls were administered self-report measures of QOL (World Health Organization Quality of Life--BREF) and postconcussive symptom severity (Neurobehavioral Symptom Inventory). Results: Perceived QOL was significantly worse in Veterans with mild-moderate TBI than in controls. In the TBI group, QOL was predominantly associated with affective symptoms, and moderate to strong correlations with fatigue and depression were evident across all QOL areas. Multivariate analyses revealed depression and fatigue to be the best predictors of Psychological, Social, and Environmental QOL, whereas sleep difficulty best predicted Physical QOL in mild-moderate TBI. Conclusion: Veterans with post-acute mild-moderate TBI evidence worse QOL than demographically matched Veteran controls. Affective symptoms, and specifically those of fatigue, depression, and sleep difficulty, appear to be the most relevant postconcussive symptoms predicting QOL in this population. These ?indings underscore the importance of examining specific symptoms as they relate to post-acute TBI QOL and provide guidance for treatment and intervention studies. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether patients with mild traumatic brain injury (mTBI) receiving text messaging-based education and behavioral support had fewer and less severe postconcussive symptoms than those not receiving text-message support. Our secondary objective was to determine the feasibility of using text messaging to assess daily symptoms and provide support to patients with mTBI. Design: Randomized controlled trial with 14-day follow-up. Participants: Convenience sample of 43 adult emergency department patients with mTBI. Intervention: Fourteen days of timed SMS (short-message service) symptom assessments (9 AM: headaches; 1 PM: difficulty concentrating; 5 PM: irritability or anxiety) with self-care support messages. Main Measures: SMS symptom reports, Rivermead Postconcussion Symptoms Questionnaire. Results: Compared with the control group, intervention participants trended to lower odds of reporting headaches (odds ratio [OR] = 0.38; 95% confidence interval [CI]: 0.07-1.99), concentration difficulty (OR = 0.32; 95% CI: 0.04-2.24), and irritability or anxiety (OR = 0.33; 95% CI: 0.05-2.35). There were also trends of lower mean scores for headaches (0.99 vs 1.19; P= .5), difficulty concentrating (0.88 vs 1.23; P= .2), and irritability/anxiety (1.00 vs 1.62; P= .06). There were high response rate to SMS symptom assessments and high satisfaction with the intervention. Conclusion: Those receiving the text messaging-based education and support had fewer and less severe postconcussive symptoms than the controls but none of the differences reached statistical significance. Further evaluation of more robust mobile interventions and larger sample of participants are still needed. [ABSTRACT FROM AUTHOR]

The article discusses impact of mild traumatic brain injury (MTBI) on postconcussive symptoms. It also discusses main measures and gives results. When evaluating patients for MTBI, clinicians should determine the lifetime history of brain injury, since past experience of MTBI could be a risk factor for increased symptoms was concluded.

Objective: To evaluate alternative models of symptom clusters for the 22-item Neurobehavioral Symptom Inventory. Participants: Three military samples, including 2 nonclinical samples (n = 2420, n = 4244) and 1 sample of individuals with recent head injury (n = 617). Methods: In the first sample, exploratory factor analysis of Neurobehavioral Symptom Inventory responses was performed with tests of significant factors and model fit. In the other 2 samples, confirmatory factor analysis evaluated the fit of 3 models: 2- and 3-factor models based on the initial exploratory factor analysis, and a 9-factor model based on prior research. Main Outcome Measures: The exploratory factor analysis used 2 tests for the number of factors: Parallel Analysis and Minimum Average Partial test. Confirmatory factor analysis models were evaluated using 2 measures of model fit, Root Mean Square Error of Approximation and Comparative Fit Index. Results: Postconcussive symptoms can be described accurately by the 9 factors. However, the model of 3 intercorrelated factors, reflecting cognitive, affective, and somatic/sensory symptoms, fits the data more parsimoniously with little loss in model fit. Conclusion: Although the 9-cluster result from prior research provides a valid description of the relations among items of the inventory, a 3-factor model, consisting of somatic/sensory, affective, and cognitive factors, provides nearly as good a fit to the data, with greater parsimony. We encourage clinicians and researchers to conceptualize the Neurobehavioral Symptom Inventory in terms of 3 coherent clusters of symptoms rather than as 22 individual items. [ABSTRACT FROM AUTHOR]

Objectives: Analyze the contribution of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) to the endorsement of postconcussive (PC) symptoms during Post Deployment Health Assessment. Determine whether a combination of mTBI and PTSD was more strongly associated with symptoms than either condition alone. Methods: Cross-sectional study design where both the exposure, mTBI and/or PTSD, and the outcomes of interest, PC symptoms, were ascertained after return from deployment. Subjects were injured soldiers (n = 1247) from one Fort Carson Brigade Combat Team (n = 3973). Main Outcome Measures: Positive history of PC symptoms. Results: PTSD and mTBI together were more strongly associated with having PC symptoms (adjusted prevalence ratio 6.27; 95% CI: 4.13-9.43) than either mTBI alone (adjusted prevalence ratio = 4.03; 95% CI: 2.67-6.07) or PTSD alone (adjusted prevalence ratio = 2.74; 95% CI: 1.58-4.74) after adjusting for age, gender, education, rank, and Military Occupational Specialty. Conclusions: In soldiers with histories of physical injury, mTBI and PTSD were independently associated with PC symptom reporting. Those with both conditions were at greater risk for PC symptoms than those with either PTSD, mTBI, or neither. Findings support the importance of continued screening for both conditions with the aim of early identification and intervention. [ABSTRACT FROM AUTHOR]

Objective: To determine whether screening for a blast mechanism of concussion identifies individuals at higher risk of persistent postconcussive symptoms (PCS). Setting: United States Army post. Participants: 3952 US Army infantry soldiers were administered anonymous surveys 3 to 6 months after returning from a yearlong deployment to Iraq. Main Outcome Measures: Self-reported concussion (defined as an injury that resulted in being "dazed, confused, or `seeing stars'"; "not remembering the injury"; or "losing consciousness [knocked out]): Patient Health Questionnaire 15-item scale for physical symptoms and PCS; Posttraumatic Stress Disorder Cheddist; and Patient Health Questionnaire depression module. Results: Of the 587 soldiers (14.9 % of the total sample) who met criteria for concussion, 201 (34.2%) reported loss of consciousness, and 373 (63.50/0) reported only an alteration of consciousness without loss of consciousness; 424 (72.2%) reported a blast mechanism, and 150 (25.6%) reported a nonblast mechanism. Among soldiers who lost consciousness, blast mechanism was significantly associated with headaches and tinnitus 3 to 6 months postdeployment compared with a nonblast mechanism. However, among the larger group of soldiers reporting concussions without loss of consciousness, blast was not associated with adverse health outcomes. Conclusions: Blast mechanism of concussion was inconsistently associated with PCS, depending on the definition of concussion utilized. A self-reported history of blast mechanism was not associated with persistent PCS for the majority of US soldiers with concussions. [ABSTRACT FROM AUTHOR]

Objective: To determine the relations between traumatic brain injury (TBI) and several neurologic outcomes 6 months or more after TBI. Participants: Not applicable. Design: Systematic review of the published, peer-reviewed literature. Primary Measures: Not applicable. Results: We identified 75 studies that examined the relations between TBI and neurologic outcomes. Unprovoked seizures are causally related to penetrating TBI as well as to moderate and severe TBI. There was only limited evidence of an association between seizures and mild TBI. Dementia of the Alzheimer's type (DAT) was associated with moderate and severe TBI, but not with mild TBI unless there was loss of consciousness (LOC); the evidence for the latter was limited. Parkinsonism was associated with moderate and severe TBI, but there was only modest evidence of a link with mild TBI without LOC. Dementia pugilistica was associated with professional boxing. There was insufficient evidence to support an association between TBI and both multiple sclerosis and amyotrophic lateral sclerosis. TBI appeared to produce a host of postconcussive symptoms (eg, memory problems, dizziness, and irritability). Moderate and severe TBI were associated with endocrine problems such as hypopituitarism and growth hormone deficiency and possibly with diabetes insipidus. There was only limited evidence of an association between mild TBI and the development of ocular/visual motor deterioration. Conclusion: TBI is strongly associated with several neurologic disorders 6 months or more after injury. Clinicians caring for TBI patients should monitor them closely for the development of these disorders. While some of these disorders can be treated after they arise (eg, seizures), a greater public health benefit would be achieved by preventing them before they develop. Research efforts to develop therapies aimed at secondary prevention are currently underway. [ABSTRACT FROM AUTHOR]