Breakthrough Study Records Prevalence & Persistence of Symptoms in TBI Patients

Posted on February 22, 2022

It is widely accepted that adverse symptoms such as headache and fatigue are common after sustaining a traumatic brain injury (TBI). However, the burden and longevity of these symptoms have long been disputed, especially with regard to mild-TBIs. This is why the “Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury” study published earlier this month by the Journal of Neurotrauma is a significant advancement in the understanding of TBIs.

This study conducted by the “Transforming Research and Clinical Knowledge in TBI” (TRACK-TBI) network at UCSF’s Brain and Spinal Injury Center revealed that TBI participants endorsed a significantly higher symptom burden than the control participants, and it was common for TBI participants to endorse symptoms 12 months post-injury at every TBI severity level, including mild-TBI.

Studying the Prevalence & Persistence of Symptoms in TBI Patients

The study followed 2,039 TBI participants at US Level 1 trauma centers, 257 orthopedic injury control (OTC) participants, and 300 friends or family control (FC) participants. The TBI participants were further divided into mild-TBI and moderate/severe-TBI categories. Every TBI participant had sustained a TBI within 24 hours prior to enrolling in the study and subsequently underwent CT imaging.

All participants were then evaluated at two-weeks, three-months, six-months, and 12 months post-injury. The evaluation included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), which tracks the severity of 16 symptoms on a scale of 0 (not experienced at all) to 4 (a severe problem). Symptoms were considered endorsed if they ranked in the 2 to 4 range.

Ultimately, a participant’s total symptom score could range anywhere between 0 to 64 by the end of each evaluation.

Key Findings of the Study

Many key findings came to light at the conclusion of this study regarding the burden and longevity of symptoms associated with TBIs generally and mild-TBIs specifically.

Starting with the symptom burden of TBIs generally, the study found that the mean and median symptom scores of TBI participants more than doubled the symptom scores of OTC and FC participants at all four evaluation points of the study.

For example, headaches were reportedly two times more prevalent in TBI participants than in OTC and FC participants. While headaches were not exclusive to TBI participants, the magnitude and frequency with which TBI participants experienced them was distinct.

Regarding improvement of the symptom burden, TBI symptom scores improved by the greatest margin between the first and second evaluations at two-weeks and three-months post-injury. Unfortunately, there was little improvement in TBI symptom scores from that time forward.

Moreover, the study revealed that the physical symptoms experienced by TBI participants were more likely to decrease in score overtime compared to more continual cognitive and emotional symptoms.

As for the longevity of symptoms in TBIs generally, the study revealed that at all four evaluation points, over 70% of TBI participants endorsed at least one symptom as new or worsened relative to before sustaining a TBI. Furthermore, the poor memory and longer-to-think symptoms scored as the most persistent symptoms in TBI participants over the four evaluations.

In addition to comparing the symptoms experienced by TBI, OTC, and FC participants, the study further compared the symptoms experienced by mild-TBI versus moderate/severe-TBI participants.

With regard to the symptom burden of mild-TBIs, the study found that during the first six months post-injury, mild-TBIs and moderate/severe-TBIs participants received similar symptom scores. However, by the conclusion of the study, mild-TBI participants scored an average of two points lower than the moderate/severe-TBI participants.

Finally, the study found the longevity of symptoms in mild-TBIs is more prolonged than previously thought; over 50% of mild-TBI participants endorsed at least three symptoms as worse than pre-injury through all 12 months of the study. This undermines the belief that mild-TBI symptoms resolve in three months, which is a popular belief founded on the results of past studies that contained weaknesses such as small sample sizes, high dropout rates, or substantial time gaps between evaluations.

A Critical Insight into the Prevalence and Persistence of Symptoms Associated with TBIs

The results of this study provide critical insight into the prevalence and persistence of symptoms associated with TBIs, especially mild-TBIs. It’s important if you are experiencing a mild-TBI to not prematurely discontinue medical care, which is a pattern that this study revealed in around half of its mild-TBI participants who were still reporting at least three moderate-to-severe symptoms at the three-months post-injury evaluation.

Suffering From a Traumatic Brain Injury? Get Legal Representation

If you are suffering from a traumatic brain injury, call Panish | Shea | Boyle | Ravipudi LLP so that we can get you the legal representation and compensation you deserve. Our attorneys have extensive experience with the complicated and lengthy lawsuits that often spring up after a brain injury and can help guide you through the process.


Machamer J, Temkin N, Dikmen S, Nelson LD, Barber J, Hwang P, Boase K, Stein MB, Sun X, Giacino

J, McCrea MA, Taylor SR, Jain S, Manley G; TRACK-TBI Investigators. Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma. 2022 Feb 9. doi: 10.1089/neu.2021.0348. Epub ahead of print. PMID: 35078327.

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