Predicting outcome following mild traumatic brain injury: protocol for the longitudinal, prospective, observational Concussion Recovery (CREST) cohort study

Aleksandra Karolina Gozt; Sarah Claire Hellewell; Jacinta Thorne; Elizabeth Thomas; Francesca Buhagiar; Shaun Markovic; Anoek Van Houselt; Alexander Ring; Glenn Arendts; Ben Smedley; Sjinene Van Schalkwyk; Philip Brooks; John Iliff; Antonio Celenza; Ashes Mukherjee; Dan Xu; Suzanne Robinson; Stephen Honeybul; Gill Cowen; Melissa Licari; Michael Bynevelt; Carmela F Pestell; Daniel Fatovich; Melinda Fitzgerald

doi:10.1136/bmjopen-2020-046460

Predicting outcome following mild traumatic brain injury: protocol for the longitudinal, prospective, observational Concussion Recovery (CREST) cohort study

BMJ Open. 2021 May 13;11(5):e046460. doi: 10.1136/bmjopen-2020-046460.

Authors

Aleksandra Karolina Gozt^{1

2}, Sarah Claire Hellewell¹, Jacinta Thorne¹, Elizabeth Thomas^{3

4}, Francesca Buhagiar⁵, Shaun Markovic^{6

7}, Anoek Van Houselt⁸, Alexander Ring^{9

10}, Glenn Arendts^{11

12}, Ben Smedley¹³, Sjinene Van Schalkwyk¹⁴, Philip Brooks^{15

16

17}, John Iliff^{17

18

19

20}, Antonio Celenza^{21

22}, Ashes Mukherjee²³, Dan Xu^{3

24}, Suzanne Robinson³, Stephen Honeybul^{25

26}, Gill Cowen¹⁷, Melissa Licari^{8

27}, Michael Bynevelt^{28

29}, Carmela F Pestell^{1

5}, Daniel Fatovich^{12

30}, Melinda Fitzgerald^{31

2}

Affiliations

¹ Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia.
² Perron Institute of Neurological and Translational Science, Nedlands, Western Australia, Australia.
³ Centre for Clinical Research Excellence, School of Population Health, Curtin University, Bentley, Western Australia, Australia.
⁴ Division of Surgery, Faculty of Health & Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia.
⁵ School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia.
⁶ Australian Alzheimer's Research Foundation, Nedlands, Western Australia, Australia.
⁷ The Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia.
⁸ School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia.
⁹ Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
¹⁰ School of Physiotherapy and Exercise Science, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia.
¹¹ Emergency Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹² Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia.
¹³ Emergency Department, Rockingham General Hospital, Cooloongup, Western Australia, Australia.
¹⁴ Emergency Department, Joondalup Health Campus, Joondalup, Western Australia, Australia.
¹⁵ Emergency Department, Saint John of God Midland Public Hospital, Midland, Western Australia, Australia.
¹⁶ School of Medicine, The University of Notre Dame and Curtin Medical School, Curtin University, Perth, Western Australia, Australia.
¹⁷ Curtin Medical School, Curtin University, Bentley, Western Australia, Australia.
¹⁸ Emergency Department, Saint John of God Hospital Murdoch, Murdoch, Western Australia, Australia.
¹⁹ Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia.
²⁰ Royal Flying Doctor Service- Western Operations, Jandakot, Western Australia, Australia.
²¹ Emergency Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
²² Division of Emergency Medicine, School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia.
²³ Emergency Department, Armadale Health Service, Mount Nasura, Western Australia, Australia.
²⁴ The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
²⁵ Statewide Director of Neurosurgery, Department of Health Government of Western Australia, Perth, Western Australia, Australia.
²⁶ Head of Department, Sir Charles Gairdner Hospital, Royal Perth Hospital and Fiona Stanley Hospital, Perth, Western Australia, Australia.
²⁷ Telethon Kids Institute, West Perth, Western Australia, Australia.
²⁸ Division of Surgery, School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia.
²⁹ The Neurological Intervention & Imaging Service of Western Australia at Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
³⁰ Emergency Medicine, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.
³¹ Curtin Health Innovation Research Institute, Curtin University Faculty of Health Sciences, Bentley, Western Australia, Australia lindy.fitzgerald@curtin.edu.au.

Abstract

Introduction: Mild traumatic brain injury (mTBI) is a complex injury with heterogeneous physical, cognitive, emotional and functional outcomes. Many who sustain mTBI recover within 2 weeks of injury; however, approximately 10%-20% of individuals experience mTBI symptoms beyond this 'typical' recovery timeframe, known as persistent post-concussion symptoms (PPCS). Despite increasing interest in PPCS, uncertainty remains regarding its prevalence in community-based populations and the extent to which poor recovery may be identified using early predictive markers.

Objective: (1) Establish a research dataset of people who have experienced mTBI and document their recovery trajectories; (2) Evaluate a broad range of novel and established prognostic factors for inclusion in a predictive model for PPCS.

Methods and analysis: The Concussion Recovery Study (CREST) is a prospective, longitudinal observational cohort study conducted in Perth, Western Australia. CREST is recruiting adults aged 18-65 from medical and community-based settings with acute diagnosis of mTBI. CREST will create a state-wide research dataset of mTBI cases, with data being collected in two phases. Phase I collates data on demographics, medical background, lifestyle habits, nature of injury and acute mTBI symptomatology. In Phase II, participants undergo neuropsychological evaluation, exercise tolerance and vestibular/ocular motor screening, MRI, quantitative electroencephalography and blood-based biomarker assessment. Follow-up is conducted via telephone interview at 1, 3, 6 and 12 months after injury. Primary outcome measures are presence of PPCS and quality of life, as measured by the Post-Concussion Symptom Scale and the Quality of Life after Brain Injury questionnaires, respectively. Multivariate modelling will examine the prognostic value of promising factors.

Ethics and dissemination: Human Research Ethics Committees of Royal Perth Hospital (#RGS0000003024), Curtin University (HRE2019-0209), Ramsay Health Care (#2009) and St John of God Health Care (#1628) have approved this study protocol. Findings will be published in peer-reviewed journals and presented at scientific conferences.

Trial registration number: ACTRN12619001226190.

Keywords: mental health; neurobiology; neurological injury; neurology; neuropathology; neuroradiology.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain Concussion* / diagnosis
Cohort Studies
Humans
Observational Studies as Topic
Post-Concussion Syndrome* / diagnosis
Prospective Studies
Quality of Life
Western Australia

Associated data

ANZCTR/ACTRN12619001226190