Nine early warning signs a concussion might last longer than expected – New Atlas

Report on Early Predictors of Persistent Post-Concussion Symptoms and Alignment with Sustainable Development Goals

Advancing SDG 3: Good Health and Well-being through Enhanced TBI Diagnosis

A recent study provides critical insights into the early identification of patients at risk for persistent symptoms following a mild traumatic brain injury (mTBI), a common reason for emergency department visits. By enabling healthcare professionals to predict which individuals may experience prolonged recovery, this research directly supports the objectives of Sustainable Development Goal 3 (Good Health and Well-being), which aims to ensure healthy lives and promote well-being for all at all ages. The ability to discern high-risk patients facilitates targeted interventions, improving long-term health outcomes.

The study’s methodology involved:

• Analysis of data from the HeadSMART II multicenter study, designed to improve diagnostic tools for head injuries.
• A cohort of 803 adults who presented to emergency departments within approximately 1.5 hours of sustaining an mTBI.
• Utilization of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 30 days post-injury to assess physical, cognitive, and emotional symptoms.
• Classification of patients with an RPQ score greater than 11 as having persistent symptoms.

Key Predictive Factors for Prolonged Concussion Symptoms

The analysis revealed that approximately 29% of patients continued to experience moderate to severe symptoms 30 days after their injury. Nine key factors were identified that significantly increased the odds of persistent symptoms. These findings have direct relevance to several Sustainable Development Goals.

1. Female sex: Highlighting a critical disparity, women were found to be twice as likely to have persistent symptoms. This underscores the importance of SDG 5 (Gender Equality) in ensuring equitable health outcomes and gender-responsive healthcare.
2. Higher body mass index (BMI): An elevated BMI was associated with a slightly increased risk, linking concussion recovery to broader public health indicators under SDG 3.
3. Mechanism of injury: Injuries resulting from falls, vehicular crashes, and abuse/assault carried more than double the risk compared to sports-related injuries. This finding connects to SDG 3.6 (halve deaths and injuries from road traffic accidents) and SDG 16 (reduce all forms of violence).
4. History of headache or migraines: Pre-existing neurological conditions were identified as a significant risk factor.
5. History of depression: This aligns with SDG 3.4, which calls for the promotion of mental health and well-being.
6. History of anxiety: Similar to depression, a history of anxiety points to the need for integrated mental and physical healthcare as promoted by SDG 3.4.
7. Presence of focal neurological deficits: The presentation of localized nerve function problems indicated a higher risk of prolonged symptoms.
8. Presence of headache at intake: An immediate symptom that serves as an early warning sign.
9. Multiple CT scans performed: The need for repeated imaging suggests greater clinical concern for injury severity, acting as a proxy for a more complex TBI.

Implications for Public Health Policy and Clinical Practice

The study’s findings empower clinicians to identify at-risk patients within hours of an injury. This early identification is crucial for implementing proactive management strategies, such as specialist referrals, patient education, and early rehabilitation. Such measures are fundamental to achieving SDG 3.8 (Universal Health Coverage) by improving the quality of essential healthcare services. By mitigating the long-term disabling effects of mTBI, these predictors help reduce the burden on both individuals and health systems, contributing to the overall goal of promoting well-being.

Study Limitations and Future Directions

The researchers acknowledged several limitations that provide context for the findings and guide future research:

• The follow-up period was limited to 30 days, and longer-term outcomes were not analyzed.
• The study relied on patient-reported questionnaires, which may be subject to bias.
• The analysis did not examine specific treatments or prevention strategies.
• While based on a prospective study, the analysis was a retrospective look at existing data.
• The analysis focused on single predictive factors, with more complex multivariable and machine learning models planned for future work.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This is the primary SDG related to the article. The entire study focuses on improving health outcomes for individuals with mild traumatic brain injury (mTBI). By identifying early predictors for persistent concussion symptoms, the research aims to “ensure healthy lives and promote well-being for all at all ages.” The goal is to facilitate better clinical management, specialist referrals, and early rehabilitation, which directly contributes to patient health and recovery.

• SDG 5: Gender Equality

  The article explicitly identifies “Female sex” as a key factor, stating that “Women were twice as likely to have persistent symptoms.” This highlights a significant health disparity between genders in the context of concussion recovery. Addressing this inequity is relevant to SDG 5, which aims to achieve gender equality and empower all women and girls, including ensuring their health and well-being.

• SDG 16: Peace, Justice and Strong Institutions

  The article lists “abuse/assault” as a mechanism of injury that more than doubles the risk of persistent symptoms. This directly connects the health issue of concussions to the broader societal problem of violence. SDG 16 aims to “promote peaceful and inclusive societies,” which includes reducing all forms of violence. The article underscores the severe health consequences of such violence.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: Reduce premature mortality from non-communicable diseases and promote mental health

  The study’s focus on improving recovery outcomes for mTBI aligns with promoting well-being. The article notes that a history of depression and anxiety are risk factors for persistent symptoms, linking brain injury to mental health. Better management of concussions contributes to the overall goal of promoting mental and physical well-being.

• Target 3.6: Halve the number of global deaths and injuries from road traffic accidents

  The article specifically identifies “vehicular crashes” as a cause of mTBI that carries “more than double the risk” of persistent symptoms compared to sports injuries. This highlights the severity of injuries from traffic accidents and reinforces the importance of road safety measures targeted by SDG 3.6.

• Target 3.d: Strengthen the capacity for early warning, risk reduction and management of health risks

  The core purpose of the research is to create an early warning system for clinicians. The article states that the findings can “help clinicians flag higher-risk patients early” to manage the health risk of long-term concussion symptoms. This directly corresponds to the goal of strengthening early warning and risk management capacities in healthcare.

• Target 16.1: Significantly reduce all forms of violence and related death rates everywhere

  By identifying “abuse/assault” as a high-risk cause of mTBI, the article provides evidence of the tangible health damage caused by violence. The data on injury severity from assault supports the objective of Target 16.1 by highlighting a specific, measurable negative outcome of violence that needs to be reduced.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Percentage of patients with persistent post-concussion symptoms

  The article states that “about 29% of patients still had symptoms after 30 days.” This figure serves as a direct baseline indicator. A reduction in this percentage over time would indicate progress in the management and treatment of mTBI, aligning with Target 3.4.

• Incidence of mTBI by cause

  The article breaks down the “mechanism of injury” into categories like “falls, vehicular crashes, and abuse/assault.” The number or rate of concussions resulting from vehicular crashes can be used as an indicator for Target 3.6, while the number resulting from abuse/assault can be an indicator for Target 16.1.

• Gender disparity in concussion recovery outcomes

  The finding that “Women were twice as likely to have persistent symptoms” establishes a clear indicator for gender-based health inequality (relevant to SDG 5). Progress could be measured by a reduction in this ratio, indicating more equitable health outcomes for concussion recovery regardless of sex.

• Rate of early intervention for high-risk patients

  The article suggests that high-risk patients could benefit from “specialist referral, education, or early rehabilitation.” An implied indicator of progress towards Target 3.d would be the rate at which patients identified with the nine risk factors are directed to these early interventions. An increase in this rate would show improved management of health risks.

4. Table of SDGs, Targets, and Indicators

Source: newatlas.com