Post-concussion symptoms: is stress a mediating factor?

Abstract

The Oxford Head Injury Service is a new service investigating the benefit of providing early follow up, including information, advice and support, initially at seven to 10 days post head injury, with continued intervention as needed. The intention is to reach those patients who would normally receive no formal follow-up service. This study is a pilot investigation into the initial presentation of post-concussion symptoms and the influence of stress, in the form of return to normal activity, to see whether this aggravates the symptoms. Twenty-one patients were initially seen in hospital between one and four days post injury and then followed up six to 19 days after discharge. A post-concussion symptom questionnaire was completed on each occasion and on the second assessment the presence or absence of stress, as defined above, was ascertained. At follow up it was found that 71 % (n = 15) were still experiencing symptoms and in 29% (n = 6) of the total sample the symptoms had become worse. The study reveals that it would be clinically unwise to rely on an assessment taken in the relatively protected hospital ward environment as an indicator of future recovery. The influence of stress was not found to be significant but our measure was crude and the sample small and therefore we would suggest that this question is still open.