Nine characteristics could identify patients at risk for persistent symptoms post-mTBI (1/15/26 Newsletter)
This week, our lead article, Nine characteristics could identify patients at risk for persistent symptoms post-mTBI, is in the Risk Reduction category.
Also in this newsletter:
Writers: John Rosseel, Zoe Marquis, Emily Sugg
Editors: Conor Gormally, Malayka Gormally, & Zoe Marquis
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Opportunities
March 20 – 22, Early bird rates through January 31: Love Your Brain Summit: Holistic Healing After Brain Injury. A 3-day online conference for patients, caregivers, and providers, centering on evidence-based holistic therapies for brain health and healing, presented by 16 experts in a range of fields. Topics include neurofeedback, trauma-informed mindfulness, gut-brain health, and non-invasive brain stimulation. Early bird rates are $49 (scholarship), $119 (standard, includes recordings/slides), and $200 (advocate/supporter). Additional information.
Thursday, January 22, 1pm PST: A free class, Music and Relaxation: Exploring the Therapeutic Potential, presented by board-certified and licensed music therapist Jake Beck, hosted by Brain Northwest. Registration is not required; Zoom link here.
Tuesday, January 27, 6pm EST: A free webinar, Treatment of Post-Concussion Symptoms Related to Screens at Work, School or Play, presented by Dr. Charles Tator, hosted by The Canadian Concussion Centre. Register in advance.
Thursday, January 29, 2pm PST: A free class, Seen in the Unseen: Understanding and Supporting Hidden Disabilities for Survivors and Partners, presented by Caterina Turner, hosted by Brain Northwest. Registration is not required; Zoom link here.
Welcome new and returning subscribers
To new subscribers, welcome! To returning subscribers, thank you for continuing to be part of our community. We hope you are having a good start of 2026. We wanted to provide a quick overview (or review) of the resources available on our website.
We have over 55 website resources for patients and advocates, which are divided into several sections:
In About Concussions, we provide a broad range of information on concussions, such as Headaches, Mental Health, and Persisting Symptoms (aka Post-Concussion Syndrome).
Our Treatments and Self-Care section covers medical and rehabilitative treatments, complementary and alternative treatments, and an overview of self-care.
In Affected Communities, we focus on different communities (such as Women, Veterans, etc.) and how concussion affects their lives specifically, plus specific resources for these communities.
The Find Providers section helps you find accredited providers in many different healthcare fields related to concussion.
Our free Concussion Care Webinar is comprehensive and also gives a patient perspective.
The biweekly Concussion Update Newsletter discusses new research and concussion news.
Click here for more details about what you can find in each section.
Risk Reduction
Nine characteristics could identify patients at risk for persistent symptoms post-mTBI
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.
Statistics
Concussion patients have an elevated risk of motor vehicle crashes after injury
A recent retrospective cohort analysis published in BMJ Open found that concussion patients have a 49% higher long-term risk of being in a serious motor vehicle crash after injury compared to patients with an ankle sprain. This concussion-related increase in risk of being in a serious motor vehicle crash is greater than the increase in risk associated with sleep apnoea or epilepsy. Additionally, in the first month after injury, the risk of motor vehicle crashes was over six times higher for concussion patients than for ankle sprain patients. The elevated risk was observed across diverse subgroups in the study population, persisted throughout the 20-year study window, and was exacerbated by repeated concussions and driving later at night. Researchers Donald Redelmeier et al. analyzed the records of 3,037,028 patients who received a diagnosis of either a concussion or an ankle sprain between 2002 and 2022. They tracked subsequent emergency room visits due to motor vehicle crashes for a median of 10 years after injury. The researchers suggest that their findings may warrant a safety warning from clinicians about the risk of motor vehicle crashes after a concussion and advice to minimize high-speed and late-night trips as much as possible, especially in the first month after injury.
Interlude from Concussion Alliance:
Motor vehicle accidents are a common cause of concussions, as well as moderate and severe TBIs. Moreover, patients who sustain multiple concussions in a short time are more likely to experience longer recoveries and persisting symptoms after concussion. Thus, the findings of this study are particularly important. According to this study, concussion patients had a 73% increase in traffic risk after a single concussion, a 114% increase after two concussions, and a 124% increase after three concussions. Combined with the findings that the risk of motor vehicle crash was highest in the first month after concussion (which is, notably, the period when sustaining an additional concussion is most dangerous), these results provide much-needed context for the risks of driving after a concussion.
In total, 200,603 patients were injured in motor vehicle crashes during the follow-up period of the study. Concussion patients had an average rate of 10.58 crashes per 1000 people annually, while ankle sprain patients had an average rate of 6.18 crashes per 1000 people annually. Patients with an ankle sprain were used as a control because they shared the same context as patients who sustained a concussion (experiencing an injury and contacting a physician), but were neurologically unaffected.
The researchers suggest that the elevated risk of motor vehicle crashes observed in concussion patients could be due to the neurological effects of concussion. They note that “past research suggests concussions can sometimes lead to neurological disabilities that could contribute to traffic risks.” However, this past research has limitations—such as small sample sizes, unrepresentative volunteers, and artificial circumstances (driving simulations rather than actual crashes). Indeed, the researchers caution that their study is correlational, and thus, they cannot conclude that concussions cause an elevated risk of motor vehicle crashes. Other limitations include the lack of data on who was at fault, distances driven, and concussion severity.
Youth
Unique symptom presentation in pediatric concussions highlights the need for individualized diagnosis protocols
A recent study published in Brain Injury by Jonathan Santana and colleagues found that pediatric concussion characteristics differ significantly with age. Specifically, older children and adolescents were more likely to be injured through sports, and reported significantly more headache, neck pain, sensitivity to sound, feeling slowed down, difficulty remembering, fogginess, and low energy. Conversely, children under 8 tended to sustain concussions through non-sport mechanisms (most commonly falls) and reported fewer symptoms overall. That younger children reported lower symptom burden could be due to lesser injury severity or to clinicians’ reliance on parental reports of observable symptoms, as young children may struggle to describe some symptoms, given their developmental stage.
These findings emphasize that clinicians cannot use a one-size-fits-all concussion protocol, especially for children under eight years old. The authors stress the dearth of diagnostic tools for children under age 8 and, therefore, the challenge for clinicians to recognize the differing symptoms of younger patients. As approximately 1.8 million concussions in the pediatric population (or mild traumatic brain injuries (mTBIs)) occur annually, this lack of tailored diagnostic tools affects a meaningful proportion of young children in the United States. Younger children exhibit unique symptoms, such as changes in appetite, increased dependence or clinginess, bedwetting, or stomachaches. These symptoms are not included on a standardized symptom checklist, but are relevant for preschoolers.
In this prospective study, data were collected on 333 pediatric concussion patients seen in several orthopedic sports medicine clinics affiliated with an LA-based hospital system from 2012 to 2023. The authors divided participant data into three age groups: 0-7 years, 8-12 years, and 13-18 years. Each group was given a concussion symptom questionnaire and a standardized physical examination, which included a neurological exam, balance testing, and a vestibulo-ocular motor screen test (assessing eye movement and balance). Patients were asked to recall immediate symptoms during the first 24 hours after their concussion as well as current symptoms during their visit.
Dr. Santana and his colleagues found that the most striking symptom reports came from the younger patient group (under age 8). Compared to the older age groups, patients under age 8 were less likely to report physical or visio-vestibular (including balance-related) symptoms and even less likely to report cognitive, emotional, or sleep problems. Differences in developmental stage and vocabulary, especially among the youngest age group, may contribute to the lower number of reported symptoms. For patients under age 13, parents helped to fill out the concussion symptom checklist; for the youngest or those unable to fill out the form, parents filled out the entirety of the symptom checklist. The authors note that younger children may not yet have the vocabulary to describe specific symptoms, and their parents may miss less obvious ones. This is supported by previous studies’ conclusions that parental questionnaire observed symptom scores are much lower in younger populations.
Additionally, there is an absence of a recommended concussion symptom checklist for patients under age 8, and the new Sport Concussion Office Assessment Tool, the SCOAT6, is not recommended for children under age 8. The study authors suggest that their findings contribute to developing a diagnostic tool tailored to the unique needs of younger patients.
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