Nine characteristics could identify patients at risk for persistent symptoms post-mTBI
By John Rosseel. This article was initially published in the 1/15/26 Edition of our Concussion Update newsletter; please consider subscribing.
Researchers Frank Peacock et al. found nine clinical characteristics associated with an increased risk of a concussion patient still having symptoms 30 days after a mild TBI (mTBI). Published in JAMA Network Open, their analysis used data from the HeadSMART II clinical trial, selecting a subgroup of 803 adults who received care at an emergency department shortly after an mTBI (median of 1.5 hours after) and who completed follow-up evaluations after 14, 30, and 90 days. The characteristics identified by the authors as being associated with increased risk of persistent symptoms were: female sex; mechanism of injury; elevated body mass index (BMI); history of depression, anxiety, or migraines/headaches; localized neurological deficits; headache after the injury; and multiple CT scans during the initial visit. Notably, as journalist Paul McClure describes in his article about this study in News Atlas, having multiple CT scans did not aggravate brain injury. Instead, “having multiple CTs was a marker of greater injury severity or diagnostic uncertainty”. Other characteristics, such as being female, were statistically valid, yet their mechanisms were not understood by the researchers. The authors highlight the clinical utility of identifying patients “who are at high risk of subsequent adverse events while they are still in the ED.” Recognizing acutely that a concussion patient is at high risk of persisting symptoms gives healthcare providers the opportunity to offer early interventions and treatment to reduce this risk and improve patient outcomes.
Using data from the HeadSMART II cohort, Peacock et al. found adult patients diagnosed with mTBI (based on a Glasgow Coma Scale of 13-15) who gave blood tests, performed several neurocognitive assessments after 14, 30, and 90 days, and provided demographic information (race, sex, age, etc). These assessments tested memory, balance, cognition, symptom severity, and several other factors. To determine symptom persistence, they used the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 30 days after the concussion. Of the 16 symptoms measured by the RPQ, if the patient reported four symptoms or more as a ‘moderate’ problem, or at least two symptoms as a ‘severe’ problem alongside at least one symptom that was a ‘moderate’ problem, their symptoms were classified as ‘persisting’. Once the data were gathered, researchers used statistical analysis to determine which characteristics were potentially associated with persisting symptoms.
The authors acknowledge several limitations within the study. First, much of the data was based on questionnaires answered by the patients rather than objective clinical assessments, leading to increased risk of bias. Secondly, since this study was an observational, retrospective analysis, further research is needed to validate these findings and draw clinically relevant conclusions. Third, the study did not examine long-term, persisting symptoms (past 30 days), which the authors encourage further research into.