The postconcussional syndrome: a rose by any other name

The Epidemiology of Hospitalized Head Injury in British Columbia, Canada

Objective:

This descriptive study seeks to identify the incidence rates of head injuries in a large Canadian province, given incident cases for a ten year period. It describes cases in terms of age standardized rates, demographics, and health care utilization.

Methods:

The analyses were done using descriptive statistics. Incidence rates were calculated using the direct method. The indicators of hospital resource utilization were: mean length of hospital stay, number of intensive care unit (ICU) stays, and mean length of stay in an ICU.

Results:

In the ten year period, British Columbia saw 48,753 admissions due to an incident head injury. The most common head injury diagnosis was an “Intracranial” injury. The year with the highest total age standardized rate was 1991/92 (174.18/100 000). The mean length of hospital stay was 7.4 days. Ten percent had an ICU stay and the mean length of stay was 4.4 days (± 4.8). The diagnosis with the longest mean length of stay was a “Fractured Skull” while of the top five E-code categories; “Motor Vehicle Traffic” had the highest mean length of stay with 12.2 days.

Conclusions:

Our study provides a much needed analysis of the incidence of head injuries in British Columbia. These rates can be compared to other provinces using the 2001 Canadian population as the standardized population. Our results indicate that there are certain “at risk” groups that warrant attention, in particular, younger men with lower socioeconomic standing. Indicators of health care utilization presented in the study should generate policy discussions.

The effectiveness of cognitive-behavioural therapy for post-traumatic headaches

Post-traumatic headache is one of the most common symptoms following mild and moderate head injury. Psychological factors are believed to play a role in the cause, maintenance and relief from chronic post-traumatic headache. This research evaluated the effectiveness of a multi-dimensional cognitive-behavioural approach towards rehabilitation of post-traumatic headaches. The sample included 20 participants with post-traumatic headaches from an original sample of 41. Participants acted as their own controls. Outcome measures consisted of self-rating questionnaires to assess headache severity, intensity, duration, functioning and emotional well-being. Emotional and functional headache characteristics were studied using a multi-dimensional investigation which included relatives' perceptions of the sufferers headaches. The intervention proved effective and beneficial for the 20 therapy participants. It is concluded that cognitive-behavioural therapy provides a useful supplement to the treatment of post-traumatic headache.

Postconcussional symptoms in chronic back pain

Checklist measures of persisting postconcussional and control symptom change (postinjury-preinjury self-ratings on 5-point scales) were compared among selected groups of consecutive referrals with traumatic back pain and concussion. Mean symptom change was not significantly different between the 2 groups. Positive correlations were found between postconcussional symptom change and psychometric measures of emotional distress for participants with valid Minnesota Multiphasic Personality Inventory profiles in the 2 groups combined. Results suggested that persisting postconcussional symptoms were not specific to concussion but were associated with increased emotional distress.