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

摘要

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.