"I don't know," is rarely a phrase we want to hear from a doctor.
Yet, for the 150,000 Ontarians diagnosed with a concussion each year, it's often the response they get, when they ask when they'll start to feel better.
The ability to determine who will recover quickly, and who will continue to suffer from symptoms has largely eluded the medical community. Until now.
With up to 20 per cent of adults with concussion experiencing symptoms that persist beyond three months post-injury, a team of researchers at the KITE Research Institute at UHN asked: "What risk factors pre-dispose an adult to long-term symptoms?"
The findings, which were published in
PLOS Medicine, have been translated into a new,
online calculator that helps doctors determine which adult patients are at greater risk of experiencing persistent concussion symptoms – and it's the only one of its kind.
"Until now, we've had no way of predicting who will bounce back, and who will continue to suffer from migraines, dizziness, and other symptoms that prevent people from fully returning to daily life," says Laura Langer, research analyst and Lead Author.
"Doctors can now use this calculator to identify those at risk for longer symptoms and develop a tailored treatment program for each patient," says Dr. Mark Bayley, Program Medical Director of Toronto Rehab and one of the co-authors on the study.
The calculator is most impactful when a patient is first diagnosed, and valid for six months, post-injury.
While data was collected in Ontario, outcomes can be scalable across Canada and beyond.
Who is at risk of long-term symptoms?
By leveraging the ICES Data Repository – a province-wide archive that integrates multiple health databases – the team captured unprecedented, comprehensive, information of Ontarians with concussions, five years pre- and two years post-injury.
They found that groups at highest risk of persistent post-concussion symptoms include:
- Adults over 61 years old
- Adults with a history of high healthcare utilization in the year prior to injury
- Adults with a history of anxiety and/or depression
- Adults with a history of personality and bipolar disorders
How the calculator works
Once doctors log onto the calculator, they're prompted to ask patients five questions relating to their health history. Based on responses, the calculator generates a score that allows doctors to quickly assess a patient's risk of prolonged recovery.
Doctors use this information, at the time a concussion is diagnosed, to create more patient-centred treatment plans. This may include more frequent monitoring, earlier referrals to specialists, a customized exercise prescription, and educational materials.
The calculator is also useful in reassuring patients with a low-risk score of the likelihood of good outcomes.
The study was funded by, and conducted in collaboration with, Ontario Neurotrauma Foundation, with support from the UHN Foundation.
