Prediction of risk of prolonged post-concussion symptoms: Derivation and validation of the TRICORDRR (Toronto Rehabilitation Institute Concussion Outcome Determination and Rehab Recommendations) score

Autor: Laura Langer, Paul Comper, David Wyndham Lawrence, Alice Kam, Seyed Mohammad Alavinia, Alan Tam, Sarah Elizabeth Patricia Munce, Mark Bayley, Lesley Ruttan
Rok vydání: 2021
Předmět:
Male
Bipolar Disorder
Epidemiology
Health Care Providers
medicine.medical_treatment
Logistic regression
Geographical locations
0302 clinical medicine
Risk Factors
Concussion
Medicine and Health Sciences
Medical Personnel
Depression (differential diagnoses)
Aged
80 and over
Ontario
Rehabilitation
Framingham Risk Score
Post-Concussion Syndrome
Headaches
General Medicine
Middle Aged
Professions
Cohort
Medicine
Female
Research Article
Cohort study
Adult
Canada
medicine.medical_specialty
Adolescent
Young Adult
03 medical and health sciences
Signs and Symptoms
Physicians
Mental Health and Psychiatry
medicine
Humans
Adults
Primary Care
Migraine
Aged
Mood Disorders
business.industry
Primary care physician
030229 sport sciences
medicine.disease
Health Care
Age Groups
Medical Risk Factors
People and Places
North America
Emergency medicine
Population Groupings
Clinical Medicine
business
030217 neurology & neurosurgery
Zdroj: PLoS Medicine, Vol 18, Iss 7, p e1003652 (2021)
PLoS Medicine
ISSN: 1549-1676
Popis: Background Approximately 10% to 20% of people with concussion experience prolonged post-concussion symptoms (PPCS). There is limited information identifying risk factors for PPCS in adult populations. This study aimed to derive a risk score for PPCS by determining which demographic factors, premorbid health conditions, and healthcare utilization patterns are associated with need for prolonged concussion care among a large cohort of adults with concussion. Methods and findings Data from a cohort study (Ontario Concussion Cohort study, 2008 to 2016; n = 1,330,336) including all adults with a concussion diagnosis by either primary care physician (ICD-9 code 850) or in emergency department (ICD-10 code S06) and 2 years of healthcare tracking postinjury (2008 to 2014, n = 587,057) were used in a retrospective analysis. Approximately 42.4% of the cohort was female, and adults between 18 and 30 years was the largest age group (31.0%). PPCS was defined as 2 or more specialist visits for concussion-related symptoms more than 6 months after injury index date. Approximately 13% (73,122) of the cohort had PPCS. Total cohort was divided into Derivation (2009 to 2013, n = 417,335) and Validation cohorts (2009 and 2014, n = 169,722) based upon injury index year. Variables selected a priori such as psychiatric disorders, migraines, sleep disorders, demographic factors, and pre-injury healthcare patterns were entered into multivariable logistic regression and CART modeling in the Derivation Cohort to calculate PPCS estimates and forward selection logistic regression model in the Validation Cohort. Variables with the highest probability of PPCS derived in the Derivation Cohort were: Age >61 years (p^ = 0.54), bipolar disorder (p^ = 0.52), high pre-injury primary care visits per year (p^ = 0.46), personality disorders (p^ = 0.45), and anxiety and depression (p^ = 0.33). The area under the curve (AUC) was 0.79 for the derivation model, 0.79 for bootstrap internal validation of the Derivation Cohort, and 0.64 for the Validation model. A limitation of this study was ability to track healthcare usage only to healthcare providers that submit to Ontario Health Insurance Plan (OHIP); thus, some patients seeking treatment for prolonged symptoms may not be captured in this analysis. Conclusions In this study, we observed that premorbid psychiatric conditions, pre-injury health system usage, and older age were associated with increased risk of a prolonged recovery from concussion. This risk score allows clinicians to calculate an individual’s risk of requiring treatment more than 6 months post-concussion.
In a retrospective study of data from a cohort of adults with a concussion diagnosis in Ontario, Laura Kathleen Langer and colleagues derive a risk score for predicting risk of prolonged post-concussion symptoms.
Author summary Why was this study done? Between 10% and20% of adults who are diagnosed with a concussion have symptoms that persist beyond 3 months post-injury. The etiology and exact clinical nature of prolonged concussion symptoms remains elusive, and potential predictive factors from the literature remain contentious. The goal of the study was to derive a risk score for prolonged post-concussion symptoms (PPCS) among adults with concussion that could enable clinicians treating patients with concussion to determine probable recovery and facilitate appropriate care pathways to improve patient quality of life and recovery. What did the researchers find? In a cohort of 587,057 adults with a diagnosed concussion, 12.5% met the criteria for PPCS at 6 months following injury. Risk of PPCS is highest among those with a pre-injury history of psychiatric disorders and history of anxiety and/or depression. Older adults and those with high levels of healthcare usage are at higher risk of developing PPCS. What do these findings mean? The risk score may aid physicians treating adults with a concussion by allowing them to quickly assess a patient’s risk of prolonged recovery and in turn facilitate tailored treatment plans as appropriate, such as encouraging return to aerobic exercise, education about concussion, timely referrals for specialized psychological care, etc. Most adults with a concussion recover by 6 months following injury; however, our results suggest that psychiatric disorders and healthcare utilization are associated with increased risk of PPCS.
Databáze: OpenAIRE
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