Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury: Prevalence and Clinical Characteristics
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Abstract
Mild traumatic brain injury is often considered a transient condition; however, a substantial proportion of survivors experience persistent physical, cognitive, emotional, and sleep-related symptoms. This study aimed to determine the prevalence and clinical characteristics of persistent post-concussive symptoms among adults following mild traumatic brain injury. A multicenter cross-sectional study was conducted among adults assessed 3–12 months after mild traumatic brain injury. Participants were recruited using consecutive sampling from hospital medical records. Persistent post-concussive symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire and were defined as the presence of at least three symptoms rated as mild, moderate, or severe. Demographic, premorbid, and injury-related characteristics were collected through structured interviews and medical-record review. Modified Poisson regression with robust variance estimation was used to identify factors associated with persistent symptoms. A total of 387 participants were included, with a mean age of 38.6 ± 13.7 years, and 43.4% were female. Persistent post-concussive symptoms were identified in 141 participants, corresponding to a prevalence of 36.4% (95% CI: 31.8–41.3). Headache was the most frequently reported symptom, followed by dizziness, fatigue, sleep disturbance, poor concentration, and forgetfulness. In the adjusted analysis, persistent symptoms were independently associated with age ≥40 years (aPR 1.29; 95% CI: 1.01–1.65), female sex (aPR 1.34; 95% CI: 1.05–1.71), previous mild traumatic brain injury (aPR 1.45; 95% CI: 1.11–1.91), premorbid headache or migraine (aPR 1.37; 95% CI: 1.06–1.78), an initial Glasgow Coma Scale score of 13–14 (aPR 1.30; 95% CI: 1.01–1.67), and acute headache or dizziness (aPR 1.57; 95% CI: 1.20–2.05). More than one-third of adults experienced persistent post-concussive symptoms 3–12 months after mild traumatic brain injury. Structured discharge education, risk-based follow-up, and standardized symptom screening may help identify individuals requiring further clinical assessment and rehabilitation.
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References
I. Abdel Aziz, K., & Qassem, T. (2025). From Trauma to Recovery: Assessing and Managing the Neuropsychiatric Impact of Traumatic Brain Injury. Annals of Clinical Psychiatry, 36(1–2), 2–14. https://doi.org/10.1177/10401237251344099
II. Adeleye, A. O., Clark, D. J., & Malomo, T. A. (2019). Trauma demography and clinical epidemiology of motorcycle crash–related head injury in a neurosurgery practice in an African developing country. Traffic Injury Prevention, 20(2), 211–215.
https://doi.org/10.1080/15389588.2018.1553085
III. Asturias, A., Knoblauch, T., Rodriguez, A., Vanier, C., Le Tohic, C., Barrett, B., Eisenberg, M., Gibbert, R., Zimmerman, L., Parikh, S., Nguyen, A., Azad, S., Germin, L., Fazzini, E., & Snyder, T. (2023). Diffusion in the corpus callosum predicts persistence of clinical symptoms after mild traumatic brain injury, a multi-scanner study. Frontiers in Neuroimaging, 2. https://doi.org/10.3389/fnimg.2023.1153115
IV. Baker, C. E., Martin, P., Wilson, M. H., Ghajari, M., & Sharp, D. J. (2022). The relationship between road traffic collision dynamics and traumatic brain injury pathology. Brain Communications, 4(2), fcac033.
https://doi.org/10.1093/braincomms/fcac033
V. Banson, M., Ametefe, M. K., Darko, K., Dakubo, J. C. B., Iddrisu, M., & Dakurah, T. (2025). Comparative Analysis of Traumatic Brain Injury Severity in Motorcycle and Car Accident Victims Treated at Korle-Bu Teaching Hospital. Journal of the West African College of Surgeons, 15(1), 75–82. https://doi.org/10.4103/jwas.jwas_188_23
VI. Biagianti, B., Stocchetti, N., Brambilla, P., & Van Vleet, T. (2020). Brain dysfunction underlying prolonged post-concussive syndrome: A systematic review. Journal of Affective Disorders, 262, 71–76.
https://doi.org/10.1016/j.jad.2019.10.058
VII. Cancelliere, C., Verville, L., Stubbs, J. L., Yu, H., Hincapié, C. A., Cassidy, J. D., Wong, J. J., Shearer, H. M., Connell, G., Southerst, D., Howitt, S., Guist, B., & Silverberg, N. D. (2023). Post-Concussion Symptoms and Disability in Adults With Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Journal of Neurotrauma, 40(11–12), 1045–1059.
https://doi.org/10.1089/neu.2022.0185
VIII. Chan, Y., Thorne, P. R., & Taylor, R. L. (2025). Self-reported dizziness, balance, and multisensory impairment following mild traumatic brain injury: An exploratory study. Journal of the Royal Society of New Zealand, 55(3), 451–465.
https://doi.org/10.1080/03036758.2024.2412095
IX. Devlin, A., Beck, B., Simpson, P. M., Ekegren, C. L., Giummarra, M. J., Edwards, E. R., Cameron, P. A., Liew, S., Oppy, A., Richardson, M., Page, R., & Gabbe, B. J. (2019). The road to recovery for vulnerable road users hospitalised for orthopaedic injury following an on-road crash. Accident Analysis & Prevention, 132, 105279.
https://doi.org/10.1016/j.aap.2019.105279
X. Eapen, B. C., Bowles, A. O., Sall, J., Lang, A. E., Hoppes, C. W., Stout, K. C., Kretzmer, T., & Cifu, D. X. (2022). The management and rehabilitation of post-acute mild traumatic brain injury. Brain Injury, 36(5), 693–702.
https://doi.org/10.1080/02699052.2022.2033848
XI. Haarbauer-Krupa, J., Pugh, M. J., Prager, E. M., Harmon, N., Wolfe, J., & Yaffe, K. (2021). Epidemiology of Chronic Effects of Traumatic Brain Injury. Journal of Neurotrauma, 38(23), 3235–3247. https://doi.org/10.1089/neu.2021.0062
XII. Hadanny, A., & Efrati, S. (2025). Persistent post-concussion syndrome: Pathophysiology, diagnosis, current and evolving treatment strategies. Expert Review of Neurotherapeutics, 25(8), 959–971. https://doi.org/10.1080/14737175.2025.2515061
XIII. Hereford, J. M. (2013). Sleep and Other Medical and Psychiatric Disorders. In Sleep and Rehabilitation. Routledge.
XIV. Holte, K. E. (2024). Characterizing Clinical Presentations following Mild Traumatic Brain Injury: Mechanisms of Injury and Dizziness Subtypes. https://doi.org/10.11575/PRISM/42896
XV. Jennings, T., & Islam, M. S. (2023). Examining the interdisciplinary approach for treatment of persistent post-concussion symptoms in adults: A systematic review. Brain Impairment, 24(2), 290–308. https://doi.org/10.1017/BrImp.2022.28
XVI. Ji, K.-H., Kim, D.-K., Kim, E.-H., & Chung, S. (2025). The Missing Link in Patient Recovery: Hospital Sleep Medicine. Sleep Medicine Research, 16(1), 7–17.
https://doi.org/10.17241/smr.2025.02782
XVII. Jiang, M., Li, C., Zhang, S., Gao, X., & Yang, X. (2023). The incidence of brain trauma caused by road injuries: Results from the Global Burden of Disease Study 2019. Injury, 54(12), 110984. https://doi.org/10.1016/j.injury.2023.110984
XVIII. Kalaria, R. N., Akinyemi, R. O., Paddick, S.-M., & Ihara, M. (2024). Current perspectives on prevention of vascular cognitive impairment and promotion of vascular brain health. Expert Review of Neurotherapeutics, 24(1), 25–44.
https://doi.org/10.1080/14737175.2023.2273393
XIX. Karr, J. E., & Logan, T. K. (2024). Post-Concussion Symptoms in Women With Head Injury Due to Intimate Partner Violence. Journal of Neurotrauma, 41(3–4), 447–463.
https://doi.org/10.1089/neu.2023.0101
XX. Kim, S. Y., Yeh, P.-H., Ollinger, J. M., Morris, H. D., Hood, M. N., Ho, V. B., & Choi, K. H. (2023). Military-related mild traumatic brain injury: Clinical characteristics, advanced neuroimaging, and molecular mechanisms. Translational Psychiatry, 13(1), 289.
https://doi.org/10.1038/s41398-023-02569-1
XXI. Kim, S.-C., Lee, H.-J., Kim, J.-M., Kong, S.-Y., Park, J.-S., Jeon, H.-J., In, Y.-N., Kim, H., Lee, S.-W., & Kim, Y.-T. (2019). Comparison of epidemiology and injury profile between vulnerable road users and motor vehicle occupants in road traffic fatalities. Traffic Injury Prevention, 20(6), 581–587.
https://doi.org/10.1080/15389588.2018.1539840
XXII. Leddy, J. J., Haider, M. N., Noble, J. M., Rieger, B., Flanagan, S., McPherson, J. I., Shubin-Stein, K., Saleem, G. T., Corsaro, L., & Willer, B. (2021). Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists. Current Neurology and Neuroscience Reports, 21(12), 70. https://doi.org/10.1007/s11910-021-01159-2
XXIII. Löwe, B., Toussaint, A., Rosmalen, J. G. M., Huang, W.-L., Burton, C., Weigel, A., Levenson, J. L., & Henningsen, P. (2024). Persistent physical symptoms: Definition, genesis, and management. The Lancet, 403(10444), 2649–2662. https://doi.org/10.1016/S0140-6736(24)00623-8
XXIV. Maas, A. I. R., Menon, D. K., Adelson, P. D., Andelic, N., Bell, M. J., Belli, A., Bragge, P., Brazinova, A., Büki, A., Chesnut, R. M., Citerio, G., Coburn, M., Cooper, D. J., Crowder, A. T., Czeiter, E., Czosnyka, M., Diaz-Arrastia, R., Dreier, J. P., Duhaime, A.-C., … Zumbo, F. (2017). Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology, 16(12), 987–1048. https://doi.org/10.1016/S1474-4422(17)30371-X
XXV. Maas, A. I. R., Menon, D. K., Manley, G. T., Abrams, M., Åkerlund, C., Andelic, N., Aries, M., Bashford, T., Bell, M. J., Bodien, Y. G., Brett, B. L., Büki, A., Chesnut, R. M., Citerio, G., Clark, D., Clasby, B., Cooper, D. J., Czeiter, E., Czosnyka, M., … Zemek, R. (2022). Traumatic brain injury: Progress and challenges in prevention, clinical care, and research. The Lancet Neurology, 21(11), 1004–1060. https://doi.org/10.1016/S1474-4422(22)00309-X
XXVI. Mavroudis, I., Ciobica, A., Luca, A. C., & Balmus, I.-M. (2023). Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies. Journal of Clinical Medicine, 12(13), 4233. https://doi.org/10.3390/jcm12134233
XXVII. Michels, F., Wastyn, H., Pottel, H., Stockmans, F., Vereecke, E., & Matricali, G. (2022). The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis. Foot and Ankle Surgery, 28(7), 817–826. https://doi.org/10.1016/j.fas.2021.12.002
XXVIII. Nielsen, K. J., Carstensen, O., Kærgaard, A., Vestergaard, J. M., & Biering, K. (2022). Neurological symptoms and disorders following electrical injury: A register-based matched cohort study. PLOS ONE, 17(3), e0264857. https://doi.org/10.1371/journal.pone.0264857
XXIX. Polinder, S., Cnossen, M. C., Real, R. G. L., Covic, A., Gorbunova, A., Voormolen, D. C., Master, C. L., Haagsma, J. A., Diaz-Arrastia, R., & von Steinbuechel, N. (2018). A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury. Frontiers in Neurology, 9. https://doi.org/10.3389/fneur.2018.01113
XXX. Quinn, D. K., Mayer, A. R., Master, C. L., & Fann, J. R. (2018). Prolonged Postconcussive Symptoms. American Journal of Psychiatry, 175, 103–111. https://doi.org/10.1176/appi.ajp.2017.17020235
XXXI. Rahman, F. N., Das, S., Kader, M., & Mashreky, S. R. (2025). Epidemiology, outcomes, and risk factors of traumatic brain injury in Bangladesh: A prospective cohort study with a focus on road traffic injury-related vulnerability. Frontiers in Public Health, 13.
https://doi.org/10.3389/fpubh.2025.1514011
XXXII. Ray, S., Luke, J., & Kreitzer, N. (2024). Patient-centered mild traumatic brain injury interventions in the emergency department. The American Journal of Emergency Medicine, 79, 183–191. https://doi.org/10.1016/j.ajem.2024.02.038
XXXIII. Rickards, T. A., Cranston, C. C., & McWhorter, J. (2022). Persistent post-concussive symptoms: A model of predisposing, precipitating, and perpetuating factors. Applied Neuropsychology: Adult, 29(2), 284–294.
https://doi.org/10.1080/23279095.2020.1748032
XXXIV. Rytter, H. M., Graff, H. J., Henriksen, H. K., Aaen, N., Hartvigsen, J., Hoegh, M., Nisted, I., Næss-Schmidt, E. T., Pedersen, L. L., Schytz, H. W., Thastum, M. M., Zerlang, B., & Callesen, H. E. (2021). Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults: A Systematic Review and Meta-analysis and Guideline Recommendation. JAMA Network Open, 4(11), e2132221.
https://doi.org/10.1001/jamanetworkopen.2021.32221
XXXV. Santoso, E. B., Suwaryo, P. A. W., & Asti, A. D. (2023). Post Concussion Syndrome Detection in Post Traumatic Brain Injury Patients. Babali Nursing Research, 4(1), 22–33.
https://doi.org/10.37363/bnr.2023.41136
XXXVI. Sayyed Hoseinian, S. H., Ebrahimzadeh, M. H. ., Peivandi, M. T., Bagheri, F., Hasani, J., Golshan, S., & Birjandinejad, A. (2019). Injury Patterns among Motorcyclist Trauma Patients: A Cross Sectional Study on 4200 Patients. Archives of Bone and Joint Surgery, 7(4), 367–372.
XXXVII. Sergeyenko, Y., Andreae, M. E., & Segal, M. (2025). Diagnosis and Management of Mild Traumatic Brain Injury (mTBI): A Comprehensive, Patient-centered Approach. Current Pain and Headache Reports, 29(1), 19. https://doi.org/10.1007/s11916-024-01333-4
XXXVIII. Shim, Y., Kim, M., Yoon, H. G., Lee, J. J., Hong, J. B., Chung, Y., Oh, J. K., & Won, Y. S. (2026). Mild Traumatic Brain Injury as a Heterogeneous Neurological Disorder: Definition, Epidemiology, Neurobiology, and Clinical Course. Korean Journal of Neurotrauma, 22(2), 78–88.
https://doi.org/10.13004/kjnt.2026.22.e18
XXXIX. Starkey, N. J., Duffy, B., Jones, K., Theadom, A., Barker-Collo, S., Feigin, V., & Group, on behalf of the B. R. (2022). Sex differences in outcomes from mild traumatic brain injury eight years post-injury. PLOS ONE, 17(5), e0269101.
https://doi.org/10.1371/journal.pone.0269101
XL. Suwaryo, P. A. W., Kadir, F., Omar, A., & Singh, S. K. D. (2024). Prevalence of Persistent Post-Concussion Syndrome in Adults After Mild Traumatic Brain Injury. Nurse Media Journal of Nursing, 14(2), 199–209.
https://doi.org/10.14710/nmjn.v14i2.56529
XLI. Suwaryo, P. A. W., Kadir, F., Omar, A., Singh, S. K. D., & Bolong, M. F. (2024). The impact of interpersonal support on quality of life in traumatic brain injury patients – a one-month post-treatment analysis. European Journal of Clinical and Experimental Medicine, 22(3), 538–542. https://doi.org/10.15584/ejcem.2024.3.8
XLII. Sýkorová, M., Nolte, E., Martineau, F., Miller, M. A., Eriksson, S. H., Smith, I. E., & Strongman, H. (2025). Barriers and facilitators to specialist service referrals for sleep disorders from healthcare professionals’ perspective: A scoping review of qualitative research evidence (p.
01.20.25320835). medRxiv. https://doi.org/10.1101/2025.01.20.25320835
XLIII. Waladani, B., Suwaryo, P. A. W., Yuniar, I., Yuwono, P., & Setianingsih, E. (2023). Predictive Value of Non-Invasive Intracranial Pressure Monitoring in Profoundly Impaired Traumatic Brain Injury Patients. Babali Nursing Research, 4(4), 714–722.
https://doi.org/10.37363/bnr.2023.44281
XLIV. Warren, J., Collinge, J., Fox, N., Mead, S., Mummery, C., Rohrer, J., Rossor, M., Schott, J., & Weil, R. (2024). Cognitive Impairment and Dementia. In Neurology (pp. 319–367). John Wiley & Sons, Ltd.