• Natalie Le Sage, Jean-Marc Chauny, Simon Berthelot, Patrick Archambault, Xavier Neveu, Lynne Moore, Valérie Boucher, Jérôme Frenette, Élaine De Guise, Marie-Christine Ouellet, Jacques Lee, Andrew D McRae, Eddy Lang, Marcel Émond, Éric Mercier, Pier-Alexandre Tardif, Bonnie Swaine, Peter Cameron, and Jeffrey J Perry.
• CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada.
• J. Neurotrauma. 2022 Oct 1; 39 (19-20): 134913621349-1362.

AbstractMild traumatic brain injury (mTBI) is a common problem. Depending on diagnostic criteria, 13 to 62% of those patients develop persistent post-concussion symptoms (PPCS). The main objective of this prospective multi-center study is to derive and validate a clinical decision rule (CDR) for the early prediction of PPCS. Patients aged ≥14 years were included if they presented to one of our seven participating emergency departments (EDs) within 24 h of an mTBI. Clinical data were collected in the ED, and symptom evolution was assessed at 7, 30 and 90 days post-injury using the Rivermead Post-Concussion Questionnaire (RPQ). The primary outcome was PPCS at 90 days after mTBI. A predictive model called the Post-Concussion Symptoms Rule (PoCS Rule) was developed using the methodological standards for CDR. Of the 1083 analyzed patients (471 and 612 for the derivation and validation cohorts, respectively), 15.6% had PPCS. The final model included the following factors assessed in the ED: age, sex, history of prior TBI or mental health disorder, headache in ED, cervical sprain and hemorrhage on computed tomography. The 7-day follow-up identified additional risk factors: headaches, sleep disturbance, fatigue, sensitivity to light, and RPQ ≥21. The PoCS Rule had a sensitivity of 91.4% and 89.6%, a specificity of 53.8% and 44.7% and a negative predictive value of 97.2% and 95.8% in the derivation and validation cohorts, respectively. The PoCS Rule will help emergency physicians quickly stratify the risk of PPCS in mTBI patients and better plan post-discharge resources.

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