Post-concussion syndrome among patients experiencing head injury attending emergency department of Hawassa University Comprehensive specialized hospital, Hawassa, southern Ethiopia

According to World Health Organization (WHO) Post-concussion syndrome (PCS) is defined as the presence of 3 or more of the following signs and symptoms after experiencing head injury such as headache, dizziness, fatigue, irritability, insomnia, difficulty of concentration, or memory difficulty [1].The diagnosis of PCS is made in people who have suffered with a head trauma when persistent post-traumatic amnesia, loss of consciousness, or post-traumatic seizures and neuropsychological impairment must be present for three months after the injury which must have been absent or less severe before the injury [2].

PCS is one of the commonest neuropsychiatric consequence after having traumatic brain injury (TBI) [3] and its onset is more often for the period of the first month after trauma, but it may continue for months even years or more after head trauma [1, 3]. The magnitude of PCS differs, however most studies reported that about 15% of individuals with a history of a single concussion develop persistent symptoms associated with the injury and these symptoms may continue last for more than three months after the head injury [4]. However, there is substantial risk of misdiagnosis of PCS, because most of the symptoms related to PCS are common or may be worsen by other disorders. For example; headaches that occur after a concussion may feel like migraine or tension-type headaches [5].

Some of the risk factors that have been associated with PCS are pre-existing medical or psychological conditions, expectations of disability, being female and older age. Physiological and psychological factors present before, during, and after the injury are all thought to be involved in the development of PCS [6] and the questions of the cause or causes of PCS have been a lot debated for many years and remain controversial [7]. Some experts found out that post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems [8]. Though, about 38% of people who experience a head injury with symptoms of concussion had no radiological evidence of brain lesions [9].

In addition, about 10% of people with PCS develop sensitivity to light or noise, about 5% experience a decreased sense of taste or smell, and about 14% report blurred vision [10] and some people may also have double vision or ringing in the ears [11].

Post-concussion syndrome (PCS), the most common entity to be diagnosed in people who have experienced TBI, is a constellation of physical, cognitive, emotional, and behavioral symptoms and its prevalence varies from 11% to 64% [12]. The prevalence of persistent symptoms at 1 year is not known, but is estimated to be 5%. There is limited information on the prevalence and incidence of PCS in children. Despite the prevalence of PCS, uncertainty exists about the validity of this diagnosis because behavioral disturbances frequently occur in children after any injury and because factors present before injury and medico legal concerns after injury may influence recovery [13]. Up to 60% of patients with minor traumatic brain injury (MTBI) will suffer from post-concussion syndrome (PCS) characterized by persistence of symptoms such as headache, fatigue, memory difficulties and emotional liability [14].

According to different researches which were done worldwide, head injuries are common health problems of the world which affects mainly productive age groups of the world and contributes strongly to costs in the health care system. In Africa, head injuries are the common health problems and are substantial causes for morbidity and mortality which mostly affects productive age group of the population and brings economic consequences for both individuals and society of the continent [15].

In Ethiopia, even though there was no research conducted on post-concussion syndrome, it is a common health problem that affect the productive age group, which directly or indirectly influences the development of the country [16]. So, since the problem affects the productive age group of the country, paying attention to carry out this study assessing the magnitude and determinants of post-concussion syndrome is most crucial.

A total of 275 cases were interviewed over five months data collection period with final response rate of 95.2%. More than half (55.7%) of patients were in age range of 25–34. Majorities (55.6%) of patients were married and 74.9% were living with family (Table 1).

This study was designed to assess prevalence of PCS and its associated factors among patients experiencing head injury and attending emergency department in Hawassa university comprehensive specialized hospital in 2018.

The Overall prevalence of PCS among patients experiencing head injury and attending emergency department in Hawassa university comprehensive specialized hospital was 41.5%. The finding of this study was higher than study done in New Zealand where more than 30% of participants reported PCS symptoms [19]. In addition it was significantly higher as compared to Malaysian [20] and Swedish [21] study which was 8.1% and 34%of patients survived from mild TBI developed PCS, respectively. The variation between the current study and the study mentioned above might be due to the difference in sample size, studies area and socioeconomic difference among study participants.

Students were 36% less likely to develop PCS compared to government employee. As it was evidenced, among study participants who experience head injury 30.5% and 16% were government employee and students by occupation respectively. This implies those who experienced head injury are more likely to develop PCS. Also, as it was commonly observed in the study area government employees uses motor bicycle compared with students, which will increase risk of road traffic accident.

Patients injured by motor bicycle were 54% less likely to develop PCS compared with those injured due to car accident. This might be due to the fact that it is obligatory to use helmets by motor bicycle drivers which protect them from head injury.

Patients who injured occipital area of the brain were 28% less likely to develop PCS compared to with those who injured on right lateral. This finding is also supported by the follow up study conducted in USA, study participants who injured on fronto temporal and parietal area were severely affected and atrophied because of head injury compared with injuries on the different part of the brain [22].

About 41.5% of study participants had at least three symptoms of PCS. Occupation, cause of injury and location of injury were significantly associated with the occurrence of PCS.

Future studies better to consider imaging finding of individuals with head injury as supportive data in addition to assessing symptoms included in the PCS tool.