Factors Associated With Persisting Symptoms After Concussion in Adults With Mild TBI
Bibliographic record
Abstract
Importance: Up to 30% of individuals who sustain a mild traumatic brain injury (mTBI) develop persisting symptoms after concussion (PSAC). Identifying acute risk factors for PSAC can enhance clinical care in adults with concussion. Objective: To evaluate summary odds ratio (OR) estimates for acute factors associated with PSAC in adults with mTBI. Data Sources: For this systematic review and meta-analysis, a systematic search of Ovid MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, and the Cochrane Central Register of Clinical Trials (studies published from 1970 to February 15, 2024) and backward reference searching was performed on February 15, 2024. Search terms were mTBI, concussion, prognostic variables, predictors, and PSAC. Study Selection: Peer-reviewed studies in English that reported clinical factors collected within 1 month (≤28 days) of injury and associated with poor outcome, specifically PSAC, more than 1 month after concussion were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Data Extraction and Synthesis: Independent extraction and quality assessment were performed by 2 author reviewers. Study characteristics and ORs were extracted using the Modified Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prognostic Factor Studies. Risk of bias was assessed using the Quality in Prognostic Studies tool. Three-level meta-analytic models examined factors associated with PSAC 1, 3, and 6 months after mTBI. Main Outcomes and Measures: Adjusted OR (AOR) estimates for the association of acute clinical measures with PSAC. Results: Thirty-four studies were reviewed; data were extracted from 15 studies (44.1%) included in the meta-analysis (592 406 adults with concussion; mean age, 29.3 years [range, 16-89 years]; 57.8% male). Acute concentration difficulty was associated with greatest odds of PSAC across all time points (AOR, 3.43 [95% CI, 1.85-6.36]). Medical history of anxiety and/or depression or of sleep disorders (AOR, 2.47 [95% CI, 1.62-3.78]) and clinical signs (loss of consciousness and amnesia; AOR, 1.90 [95% CI, 1.28-2.84]) were associated with increased odds of PSAC across all time points. At 1 month (AOR, 3.12 [95% CI, 1.43-6.82]) and 6 months (AOR, 26.81 [95% CI, 3.42-210.06]), difficulty concentrating was associated with greatest odds of PSAC, while medical history of anxiety and/or depression or of sleep disorders was associated with greatest odds of PSAC at 3 months (AOR, 2.92 [95% CI, 1.39-6.14]). Conclusions and Relevance: In this systematic review and meta-analysis, acute cognitive symptoms, medical history of anxiety and/or depression or of sleep disorders, and the presence of clinical signs (loss of consciousness and amnesia) were the factors associated with greatest odds of PSAC in adults across all time points. The findings suggest that evaluating specific acute symptoms and signs may contribute to the prognosis of PSAC in adults.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".