Prevalence of post-concussion-like symptoms in the general population in Italy, The Netherlands and the United Kingdom, 2019, Voormolen et al

[Andy]

ABSTRACT
Objectives: To evaluate the frequency of post-concussion symptoms and prevalence and risk factors of post-concussion syndrome (PCS) in the general population, investigate the association between the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and self-perceived health, and evaluate differences between three European countries.

Methods: A web-based survey including the RPQ and EQ-5D was conducted among representative samples in three European countries.

Results: A total of 11,759 respondents completed the questionnaire. The most frequently reported symptom was fatigue (49.9%). Almost half (45.1%) of the respondents were classified as having PCS considering rating score 2 (three RPQ items with score ≥ 2) as a cut-off. Chronic health complaints were found as a significant risk factor for PCS. All items of the RPQ were positively correlated with the EQ-5D and the strongest positive correlation (0.633, p<0.001) was between RPQ item ‘feeling depressed or tearful’ and EQ-5D domain ‘anxiety/depression’.

Conclusions: We found a high frequency of post-concussion-like symptoms and PCS in the general population, indicating that these symptoms are not specific for patients with traumatic brain injury (TBI), and PCS is not a unique syndrome after TBI. Therefore, the use of post-concussion symptoms and PCS as outcome following mild TBI should be interpreted with caution.

Open access at https://www.tandfonline.com/doi/full/10.1080/02699052.2019.1607557

The authors claim they are looking at post-concussion syndrome yet

Another limitation is based on the fact that there were no questions asked if respondents had experienced a concussion, TBI or brain injury in their life or trauma’s in general.

So when they report that

The most frequently reported symptom was fatigue (49.9%) followed by sleep disturbance (42.4%) (Figure 1). The least reported symptom was double vision (10.7%). The patterns for the reported post-concussion symptoms in the individual countries were quite similar. Fatigue was also the most frequently reported symptom in each country (UK: 52.6%, the Netherlands: 48.4% and Italy: 48.1%), followed by sleep disturbance (UK: 47.0%, the Netherlands: 40.1%), except for Italy where being irritable was the second most reported symptom (Italy: 44.0%). When using rating score 3 as a cut-off the same pattern is detected (Appendix A).

Almost half (45.1%) of the respondents were classified as having PCS considering rating score 2 (three RPQ items with score ≥ 2) as a cut-off (Table 2). When using rating score 3 (three RPQ items with score ≥ 3) as a cut-off, this prevalence rate dropped substantially to 17.5%. When we inspected all respondents with chronic health complaints, higher PCS prevalence rates were found for every single complaint compared to the sample as a whole. Furthermore respondents with memory problems due to a neurological disease/dementia had the highest percentage of PCS prevalence for rating score 2 (81.9%) and rating score 3 (53.4%). The prevalence of PCS differed per country with the UK (47.8%) having the highest prevalence rates. When using rating score 3 as a cut-off, the biggest drop in prevalence rate is seen in Italy, which implies that Italians report less frequently moderate problems.

from this list of symptoms

Prevalence and severity of post-concussion symptoms were evaluated by the use of the RPQ. A total of 16 different post-concussion symptoms are described in the RPQ, which include headaches, dizziness, nausea/vomiting, noise sensitivity, sleep disturbance, fatigue, being irritable, feeling depressed or tearful, feeling frustrated or impatient, forgetfulness, poor concentration, taking longer to think, blurred vision, light sensitivity, double vision and restlessness.

I expect that they are re-labelling people who have an assortment of conditions, including ME.

 

[Inara]

Another limitation is based on the fact that there were no questions asked if respondents had experienced a concussion, TBI or brain injury in their life or trauma’s in general.

I beg your pardon? Is this right? They looked at post concussion problems without knowing (or even asking) if people had a concussion prior to symptoms? Can this be correct? I think I don't get the sense of the study...
After re-reading "objectives" I am not sure if the study makes sense.

Wouldn't a PCS questionnaire only make sense in people who've had a concussion prior to symptoms? Or are people using a PCS questionnaire to decide whether a person has had a concussion prior to symptoms and the study wants to show that's not a good way to do it? (Surprise surprise!) I don't think the study can conclude this though?

 

[roller*]

concussion is also, when quite beaten around the head by parent ? i would think.

another thing i wonder:
can this concussion/trauma effect also be applied to the lungs ? (e.g. near-drowning-experience ...) ?
or other organs even ?

 

[Barry]

In this post https://www.s4me.info/threads/the-me-show-series-two.7873/page-5#post-155154 Dr. Nina Muirhead says that her experience of ME's cognitive issues is akin to concussion ...

Unless you’ve had it you really don’t have a clue as to how awful you can feel and how it’s almost like having concussion, and you have no control over your energy levels, you can’t even think straight at times.

Dr. Muirhead has ME and is a Dr. and surgeon, so is presumably very well qualified to make that statement. And it does strongly suggest that pwME (and maybe people with other conditions also) can experience concussion-like symptoms; something that is well worth knowing. But for the survey done for this paper, it sounds like many people will not be at all qualified to make that observation, and could just muddy the waters.

 

[Sly Saint]

list of symptoms

I note that some 'emotional/behavioural symptoms' have been included. This is taking the description of concussion in a different direction which is not what (as I understand it) neurologists would test/be looking for.

see my post here from a while ago.
https://www.s4me.info/threads/patie...aise-2018-jason-et-al.5130/page-2#post-118670

the symptoms

• Headache or a feeling of pressure in the head
• Confusion or feeling as if in a fog
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea
• Vomiting
• Slurred speech
• Delayed response to questions
• Appearing dazed
• Fatigue

 

[Arnie Pye]

I note that some 'emotional/behavioural symptoms' have been included.

Doesn't every study these days have to include a mention of symptoms that are potentially of interest in mental health? These are the gateway symptoms that allow doctors to ignore everything else the patient complains of and say that the patient is mentally ill and needs CBT and then should be discharged.

 

[Mithriel]

If I am reading this correctly they gave people a questionnaire which is used to document symptoms after you have had a concussion. If someone had more than a few positive answers this was taken as post concussion being common in the community.

I really wonder about education today. How could someone come up with this research, someone pay for it and then someone publish it?

If you go to any shop in the country and ask the staff if they feel fatigue most of them will say "yes". Most people feel more fatigued than they would like.

To give them the benefit of the doubt maybe they are trying to say that concussion is a physical insult to the brain so all these symptoms must be caused by physical problems not thoughts so FND is rubbish ... nah, I don't think so either

 

[Inara]

I had two concussions, one moderate-severe as a child and one mild-moderate when I already had ME (it accelerated the disease profoundly; but of course the concussion was tension headache, according to one doctor to whom I went then I didn't rest enough - which was a HUGE error in hindsight, although I should have known better from the previous one, and since it was "really" tension headache I wasn't told to rest, but was prescribed massages). I think the comparison between both is not that bad, especially when the "acute" phase of concussion is over (e.g. the heavy tiredness that leads to unconsciousness has resolved - I don't have unconscious-like tiredness like that on a daily basis as part of ME). But I think everybody is different and will experience symptoms slightly different, and then there's severity, so some will relate to this comparison and some won't.

 

[Inara]

I note that some 'emotional/behavioural symptoms' have been included.

I don't know PCS and if emotional symptoms are actually part of it, I just know that during the acute phase of concussion you simply have no resources for emotions or whatever; but to be fair that was just my experience. I was really knocked out, the first time unconscious for one or two days (in hospital), the second for 10 hours or so. This heavy unconscious-like tiredness set in after a few hours, and then that's it.

 

[rvallee]

indicating that these symptoms are not specific for patients with traumatic brain injury (TBI), and PCS is not a unique syndrome after TBI

Uh, no. What it indicates is that the definition that they used is invalid because it creates an enormous amount of false positives.

Rejecting reality and substituting their own is the name of the game. Complete waste of funding and resources, yet again.