Development of a Prediction Model for Post-Concussive Symptoms following Mild Traumatic Brain Injury: A TRACK-TBI Pilot Study

Cnossen MC, Winkler EA, Yue JK, Okonkwo DO, Valadka A, Steyerberg EW, Lingsma HF, Manley GT
Year of publication
Journal of Neurotrauma

Post-concussive symptoms occur frequently after mild traumatic brain injury (mTBI) and may be categorized as cognitive, somatic, or emotional. We aimed to: 1) assess whether patient demographics and clinical variables predict development of each of these three symptom categories, and 2) develop a prediction model for six-month post-concussive symptoms. MTBI patients (Glasgow Coma Scale score 13-15) from the prospective multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study (2010-2012) who completed the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at six-months post-injury were included. Linear regression was utilized to determine the predictive value of candidate predictors for cognitive, somatic, and emotional subscales individually as well as the overall RPQ. The final prediction model was developed using Lasso shrinkage and bootstrap validation. We included 277 mTBI patients (70% male, median age 42y). No major differences in the predictive value of our set of predictors existed for the cognitive, somatic, and emotional subscales, and therefore one prediction model for the RPQ total scale was developed. Years of education, pre-injury psychiatric disorders and prior TBI were the strongest predictors of six-month post-concussive symptoms. The total set of predictors explained 21% of the variance, which decreased to 14% after bootstrap validation. Demographic and clinical variables at baseline are predictive of six-month post-concussive symptoms following mTBI, however these variables explain less than one-fifth of the total variance in outcome. Model refinement with larger datasets, more granular variables, and objective biomarkers are needed before implementation in clinical practice.