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Neurogenic and Psychogenic Acute Postconcussion Symptoms Can Be Identified After Mild Traumatic Brain Injury

Mounce, Luke T. A. PhD; Williams, W. Huw PhD, DClinPsy; Jones, Janelle M. PhD; Harris, Adrian MBBS, DCH, MRCP (part 1), FRCS Ed (A&E), FFAEM, DIMC RCS Ed; Haslam, S. Alexander PhD; Jetten, Jolanda PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: September/October 2013 - Volume 28 - Issue 5 - p 397–405
doi: 10.1097/HTR.0b013e318252dd75
Original Articles

Objectives: As provenance of postconcussion symptoms after mild traumatic brain injury (mTBI) is controversial, with similar rates found in other populations, we aimed to identify postconcussion symptoms specific to mTBI compared with controls. We also compared differences between complicated and uncomplicated mTBIs.

Setting: Hospital emergency department.

Participants: Adult individuals (34 individuals with complicated mTBI, 76 individuals with uncomplicated mTBI, and 47 orthopedic controls) who sought care in the emergency department and were consecutively recruited by post at 2 weeks postinjury.

Main Measures: Rivermead Postconcussion Symptom Questionnaire. Preinjury factors were used as covariates.

Results: Compared with orthopedic controls, complicated mTBI group reported greater severity of headaches, dizziness, and nausea, as well as concentration difficulties, suggesting that these are neurogenic. Severity of other symptoms measured on the Rivermead Postconcussion Symptom Questionnaire was not significantly different between these groups, suggesting that these are psychogenic. Differences were evident between the 2 mTBI samples on the items of dizziness, nausea, fatigue, sleep disturbance, and concentration difficulties.

Conclusions: Neurogenic and psychogenic postconcussion symptoms were identified at the acute-phase postinjury. Findings suggest that treating persons with mTBI as a homogenous sample is not prudent. This should inform prognostic models and follow-up support offered after leaving the emergency department.

Centre for Clinical Neuropsychological Research, University of Exeter (Drs Mounce, Haslam, and Williams); Emergency Department, Royal Devon and Exeter Foundation Trust (Mr Harris), Exeter, United Kingdom; and School of Psychology, University of Queensland, Brisbane, Queensland, Australia (Drs. Jones and Jetten).

Corresponding Author: Luke T. A. Mounce, PhD, Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Washington, Singer Laboratories, Perry Road, Exeter EX4 4QG, United Kingdom (

This study was funded by The Economic and Social Research Council.

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins