J Emerg Med. 2025 Oct 10;80:211-219. doi: 10.1016/j.jemermed.2025.10.008. Online ahead of print.

BACKGROUND: Experts recommend administering a traumatic brain injury (TBI) symptom checklist as part of routine evaluation for TBI with Glasgow Coma Scale score 13-15 («mild» TBI [mTBI]) in adult emergency departments (EDs). However, such assessment is not routine, partly due to limited guidance on interpreting symptom scores.

OBJECTIVES: Assess the utility of Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores, assessed in-hospital within 24 h of injury (day 1), in discriminating individuals with, vs. without, persistent TBI-related symptoms (persistent post-concussive symptoms [PPCS]) at 3 months post-injury, and provide interpretive guidance.

METHODS: Adults with mTBI across three Level I trauma centers completed the RPQ at day 1 and 3 months post-injury. Using binary logistic regression models and fivefold internal cross-validation, we calculated the mean area under the curve (AUC) for day 1 RPQ total score in predicting 3-month PPCS. Clinical interpretation tables were provided.

RESULTS: Two hundred fifty-two participants who completed a day 1 RPQ were included in the analysis. Inverse probability weighting was used to adjust for bias in attrition (n = 168 followed). The mean cross-validated AUC was 0.84 using day 1 RPQ score alone. Multivariable models, including those using previously validated sets of variables, did not outperform day 1 RPQ alone.

CONCLUSIONS: In adults presenting to Level I trauma centers for acute mTBI, symptom burden (RPQ total score) is robustly associated with 3-month symptom outcome. The RPQ, which can be completed in about 3 min, may support recognition of mTBI symptoms in the ED and risk stratification for triage into appropriate follow-up pathways.

PubMed:41297111 | DOI:10.1016/j.jemermed.2025.10.008