Characteristics and symptoms of concussion in the ER that indicate increased likelihood of persisting symptoms at one month post-injury

This article was initially published in the 4/16/26 edition of our Concussion Update newsletter; please consider subscribing.

A study by McIntosh et al. found that, for adults who presented with a concussion at the emergency department (ED) at a level 1 trauma center, certain characteristics and symptoms were significantly associated with an increased risk of persisting symptoms after concussion (PSaC) at one month post-injury. These characteristics and symptoms include female sex, post-traumatic amnesia, acute emotional or cognitive symptoms, and severe acute physical symptoms. Published in Neurology, the authors note that their study “uniquely contributes to the field by incorporating daily symptom tracking—a method not previously used in prognostic studies—to improve understanding of variables associated with time to recovery.” Female sex was a notable risk factor for PSaC; women took “twice as long to recover as men.” While only 50% of the participants were female, 70.6% of those with PSaC after 1 month were female. The presence of post-traumatic amnesia increased the odds of PSaC 5-fold, and also doubled recovery time. Acute, severe physical symptoms (headache, dizziness, neck pain, nausea, fatigue, etc) increased time to recovery by 8.4%. Acute emotional symptoms (irritability, sadness, anxiety) increased time to recovery by 5.5%. The authors advocate for emotional screening in the ED and referral for interventions such as cognitive behavioral therapy and other therapies, which research has shown to “reduce post-concussion symptoms, anxiety, and stress in adults with concussion.” For those with severe physical symptoms, the authors suggest symptom-specific treatments.

Recruited study participants were between the ages of 18 and 65, without evidence of intracranial abnormalities, and with no history of neurological disorder or prior moderate to severe TBI. These patients were evaluated by a healthcare professional after injury and discharged when deemed fit to leave. They were sent the Post-Concussion Symptom Checklist (PCSC) daily via text to evaluate their symptom progression with the focus on their recovery at the 1-month mark. This method allowed the researchers to track symptoms from day to day and determine the precise timing of symptom resolution. The researchers focused on specific characteristics identified in a previous systematic review and meta-analysis, including  age, sex, post-traumatic amnesia, medical history, number of previous concussions, physical/cognitive/emotional symptoms, and sleep ability, all of which were self-reported. 150 participated in total with a 50/50 male-female divide.

McIntosh et al. acknowledge limitations in their sample size and their method of data collection. They emphasize the difficulty of using self-reported data, particularly about cognitive impairment. McIntosh et al. encourage further research using larger cohorts and a standardized health care tool to collect data and provide personalized care to each patient.