Predicting recovery outcomes following mild traumatic brain injury in an Australian community cohort: Results from the Concussion Recovery Study (CREST)

Background Most people recover well following mild traumatic brain injury (mTBI). However, some experience persisting post-concussion symptoms (PPCS) for months or years. Our aims were (i) to evaluate the presence and impact of PPCS on return to functional activities over a 12-month period; and (ii) identify pre-, peri- and post-injury factors predictive of PPCS in an Australian community-based cohort at 3- and 12-months. Methods Adults (18–65 years) with mTBI were assessed by telephone within 7 days post-injury to capture demographics, pre-injury health status, injury circumstances (including mechanism, site of head impact) and symptoms. The primary outcome measure was the presence of PPCS, measured with the Post-Concussion Symptom Scale (PCSS). Logistic regression identified predictors of PPCS at 3- and 12-months. Results Of 232 participants, 49.7% had PPCS at 3-months and 45.6% at 12-months. Return to work was 96.7% at 3-months and 96.9% at 12-months, despite nearly 50% reporting PPCS. Participants with a high initial symptom burden (PCSS ≥30) were six times more likely to experience PPCS at 3-months (adjusted odds ratio [aOR] 6.17, 95% CI 2.63–14.46) and three times as likely to have PPCS at 12-months (aOR 2.70, 95% CI 1.01–7.23). Acute symptoms of “feeling slow” or “nervousness” predicted PPCS at 3-months (aOR 2.97 and 2.74, respectively), but not at 12-months. Conclusion Of those who completed follow-up, nearly half had persistent symptoms at 12-months, often continuing to work despite symptoms. High initial symptom severity and acute symptoms may help clinicians identify those needing early targeted follow-up to reduce the burden of PPCS.

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Journal
PLoS ONE
Published
2026-10-07
DOI
https://doi.org/10.1371/journal.pone.0339248
Primary Topic
Traumatic Brain Injury Research
Type
article
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article

Predicting recovery outcomes following mild traumatic brain injury in an Australian community cohort: Results from the Concussion Recovery Study (CREST)

Glenn Arendts, Ben Smedley, Carmela Pestell, Antonio Celenza et al.
PLoS ONE
Traumatic Brain Injury Research
article

Predicting recovery outcomes following mild traumatic brain injury in an Australian community cohort: Results from the Concussion Recovery Study (CREST)

Glenn Arendts, Ben Smedley, Carmela Pestell, Antonio Celenza, Caerwen S. Beaton, Dan Xu, Jacinta Thorne, Michael Bynevelt, Ruth Young, Gill Cowen, Aleksandra Gozt, Stephen Honeybul, Nicole Ghedina, Amanda Jefferson, Sjinene Van Schalkwyk, John Charles Iliff, Jemma Keeves, Sarah C. Hellewell, Francesca Buhagiar, Alexander Ring, Elizabeth Thomas, Daniel Fatovich, Melinda Fitzgerald, HuiJun Chih, Melissa Licari, Suzanne Robinson, Melissa Papini, Monica Marton
article en

Abstract

Background Most people recover well following mild traumatic brain injury (mTBI). However, some experience persisting post-concussion symptoms (PPCS) for months or years. Our aims were (i) to evaluate the presence and impact of PPCS on return to functional activities over a 12-month period; and (ii) identify pre-, peri- and post-injury factors predictive of PPCS in an Australian community-based cohort at 3- and 12-months. Methods Adults (18–65 years) with mTBI were assessed by telephone within 7 days post-injury to capture demographics, pre-injury health status, injury circumstances (including mechanism, site of head impact) and symptoms. The primary outcome measure was the presence of PPCS, measured with the Post-Concussion Symptom Scale (PCSS). Logistic regression identified predictors of PPCS at 3- and 12-months. Results Of 232 participants, 49.7% had PPCS at 3-months and 45.6% at 12-months. Return to work was 96.7% at 3-months and 96.9% at 12-months, despite nearly 50% reporting PPCS. Participants with a high initial symptom burden (PCSS ≥30) were six times more likely to experience PPCS at 3-months (adjusted odds ratio [aOR] 6.17, 95% CI 2.63–14.46) and three times as likely to have PPCS at 12-months (aOR 2.70, 95% CI 1.01–7.23). Acute symptoms of “feeling slow” or “nervousness” predicted PPCS at 3-months (aOR 2.97 and 2.74, respectively), but not at 12-months. Conclusion Of those who completed follow-up, nearly half had persistent symptoms at 12-months, often continuing to work despite symptoms. High initial symptom severity and acute symptoms may help clinicians identify those needing early targeted follow-up to reduce the burden of PPCS.

PLoS ONEVol. 21(10)
University of Notre Dame (US), Deakin University (AU), The Kids Research Institute Australia (AU), Murdoch University (AU), The University of Western Australia (AU), Curtin University (AU), Royal Perth Hospital (AU), Harry Perkins Institute of Medical Research (AU), Fiona Stanley Hospital (AU), Sir Charles Gairdner Hospital (AU), St John of God Murdoch Hospital (AU), The First Affiliated Hospital, Sun Yat-sen University (CN), Perron Institute for Neurological and Translational Science (AU), Rockingham General Hospital, Monash University (AU)
Openalex Percentile: Top 12%
Traumatic Brain Injury Research
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