The Prognostic Value of a Screening Tool for Psychological Risk Factors After Mild Traumatic Brain Injury: Prospective Studies in Canada and New Zealand

Abstract

OBJECTIVE: To investigate the prognostic value of the Subgroups for Targeted Treatment (STarT) Screening Tool adapted for concussion (STarT-C) on persistent symptoms and disability at 6-9 months following mild traumatic brain injury (mTBI). DESIGN: Secondary analysis of two prospective studies: an observational cohort study in New Zealand and usual care control arm of a clinical trial in Canada (ClinicalTrials.gov Registry (NCT04704037)). SETTING: Participants in the New Zealand cohort were recruited from concussion clinics (five sites) and those in the Canadian cohort were recruited from emergency departments/urgent care centres (eight sites). PARTICIPANTS: New Zealand participants (n=93, median age 37 years, 60% women) were assessed at median=6 weeks post-injury (T1) and 6 months later (T2). Canadian participants (n=223, median age 38 years, 56% women) were assessed at median=2 weeks (T1) and 6 months later (T2). MAIN OUTCOME MEASURES: Symptoms at T2 were assessed using the validated Rivermead Postconcussion Symptoms Questionnaire (RPQ) and disability using the WHO Disability Assessment Schedule 2.0 12-item Interview. RESULTS: In linear regression analyses, the STarT-C predicted symptom burden (R2=18-36%) and disability (R2=15-18%) at T2 in both cohorts. While the additional prognostic value over and above baseline variables was substantial (delta R2 8-40%), the additional prognostic value over the RPQ at T1 was variable and generally lower (delta R2=1-9%). CONCLUSION: The STarT-C-a brief screening tool-predicted persistent symptoms and disability in adults following mTBI. The incremental prognostic value of the STarT-C over the RPQ may be variable, but regardless, the tool may be useful for identifying those at risk of prolonged recovery who may benefit from early psychological intervention.