CC BY-NC-ND 4.0 · Current Research: Concussion 2017; 04(01): e14-e22
DOI: 10.1055/s-0037-1606578
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Latent Class Analysis of Brain Injury Symptomatology among College Students

Karen Hux
1   Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska
,
Jessica Brown
2   Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Minnesota
,
Matthew Lambert
1   Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska
› Author Affiliations
Further Information

Publication History

23 September 2016

04 August 2017

Publication Date:
18 September 2017 (online)

Abstract

Background Incidents potentially causing mild brain injury (BI) are common, and most people recover rapidly; however, a subset experiences long-lasting challenges.

Objective This study used latent class analysis to identify a subset of college students presenting chronic symptomatology consistent with a mild BI diagnosis and pseudo-class mean equality tests to examine relations between latent classes and BI event and academic outcome variables.

Methods Participants were 118/423 undergraduates self-reporting possible mild BIs through a survey about general health, daily habits, academic performance, and potential BI events. Twenty-four cognitive, physiological, or socio-emotional sequelae served to identify symptomatology profiles.

Results A three-class model including 11% with high symptomatology, 49% with moderate symptomatology, and 40% with negligible symptomatology provided excellent fit and entropy. Symptoms best separating high and moderate classes were memory, thinking speed, new learning, and attention problems. Mean equality tests revealed no significant difference in number of BI events across classes, but high symptomatology respondents were significantly less likely to lose consciousness and significantly more likely to have lower grade point averages and to have failed courses than moderate symptomatology respondents.

Discussion Cognitive problems are paramount in distinguishing college students with chronic high symptomatology following BI from those with moderate and negligible symptomatology. Because high symptomatology class individuals differ academically from their counterparts, a functional consequence of mild BI appears to exist.

Conclusion About 1 in 10 undergraduate students self-reporting BI events experiences chronic symptomatology affecting general health and academic achievement. Because they may benefit from supportive services, accurate identification is critical.

 
  • References

  • 1 Brain Injury Association of America. What is the difference between an acquired brain injury and a traumatic brain injury?. 2015 . Available at: www.biausa.org/FAQRetrieve.aspx?ID=43913
  • 2 Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG. ; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 43 (43, Suppl): 113-125
  • 3 Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, Dewey D. Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics 2010; 126 (02) e374-e381
  • 4 Carroll LJ, Cassidy JD, Peloso PM. , et al; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 36 (43, Suppl): 84-105
  • 5 Emanuelson I, Andersson Holmkvist E, Björklund R, Stålhammar D. Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: a population-based study in western Sweden. Acta Neurol Scand 2003; 108 (05) 332-338
  • 6 McAllister TW, Arciniegas D. Evaluation and treatment of postconcussive symptoms. NeuroRehabilitation 2002; 17 (04) 265-283
  • 7 McCrory P, Meeuwisse WH, Aubry M. , et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013; 47 (05) 250-258
  • 8 Røe C, Sveen U, Alvsåker K, Bautz-Holter E. Post-concussion symptoms after mild traumatic brain injury: influence of demographic factors and injury severity in a 1-year cohort study. Disabil Rehabil 2009; 31 (15) 1235-1243
  • 9 Sterr A, Herron KA, Hayward C, Montaldi D. Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome. BMC Neurol 2006; 6: 7
  • 10 van der Naalt J, van Zomeren AH, Sluiter WJ, Minderhoud JM. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry 1999; 66 (02) 207-213
  • 11 Stålnacke BM, Björnstig U, Karlsson K, Sojka P. One-year follow-up of mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction in relation to serum levels of S-100B and neurone-specific enolase in acute phase. J Rehabil Med 2005; 37 (05) 300-305
  • 12 Daneshvar DH, Riley DO, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Long-term consequences: effects on normal development profile after concussion. Phys Med Rehabil Clin N Am 2011; 22 (04) 683-700 , ix
  • 13 Bazarian JJ, McClung J, Shah MN, Cheng YT, Flesher W, Kraus J. Mild traumatic brain injury in the United States, 1998--2000. Brain Inj 2005; 19 (02) 85-91
  • 14 Hux K, Bond V, Skinner S, Belau D, Sanger D. Parental report of occurrences and consequences of traumatic brain injury among delinquent and non-delinquent youth. Brain Inj 1998; 12 (08) 667-681
  • 15 Hux K, Dymacek R, Childers C. Possible brain injury events and symptoms in elementary school children. Brain Inj 2013; 27 (12) 1348-1355
  • 16 Kennedy MR, Krause MO, Turkstra LS. An electronic survey about college experiences after traumatic brain injury. NeuroRehabilitation 2008; 23 (06) 511-520
  • 17 Krause M, Richards S. Prevalence of traumatic brain injury and access to services in an undergraduate population: a pilot study. Brain Inj 2014; 28 (10) 1301-1310
  • 18 Dick RW. Is there a gender difference in concussion incidence and outcomes?. Br J Sports Med 2009; 43 (Suppl. 01) i46-i50
  • 19 Moore DW, Ashman TA, Cantor JB, Krinick RJ, Spielman LA. Does gender influence cognitive outcome after traumatic brain injury?. Neuropsychol Rehabil 2010; 20 (03) 340-354
  • 20 Ponsford J, Draper K, Schönberger M. Functional outcome 10 years after traumatic brain injury: its relationship with demographic, injury severity, and cognitive and emotional status. J Int Neuropsychol Soc 2008; 14 (02) 233-242
  • 21 Broshek DK, Kaushik T, Freeman JR, Erlanger D, Webbe F, Barth JT. Sex differences in outcome following sports-related concussion. J Neurosurg 2005; 102 (05) 856-863
  • 22 Covassin T, Schatz P, Swanik CB. Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes. Neurosurgery 2007; 61 (02) 345-350 , discussion 350–351
  • 23 Farace E, Alves WM. Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 2000; 93 (04) 539-545
  • 24 Santa Maria MP, Pinkston JB, Miller SR, Gouvier WD. Stability of postconcussion symptomatology differs between high and low responders and by gender but not by mild head injury status. Arch Clin Neuropsychol 2001; 16 (02) 133-140
  • 25 Kraus JF, Peek-Asa C, McArthur D. The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus 2000; 8 (01) e5
  • 26 Galdas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. J Adv Nurs 2005; 49 (06) 616-623
  • 27 Hukkelhoven CW, Steyerberg EW, Rampen AJ. , et al. Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 2003; 99 (04) 666-673
  • 28 Steyerberg EW, Mushkudiani N, Perel P. , et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med 2008; 5 (08) e165 , discussion e165
  • 29 Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J. Functional plasticity or vulnerability after early brain injury?. Pediatrics 2005; 116 (06) 1374-1382
  • 30 Babikian T, Asarnow R. Neurocognitive outcomes and recovery after pediatric TBI: meta-analytic review of the literature. Neuropsychology 2009; 23 (03) 283-296
  • 31 Kirkwood MW, Yeates KO, Wilson PE. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics 2006; 117 (04) 1359-1371
  • 32 Huh JW, Widing AG, Raghupathi R. Midline brain injury in the immature rat induces sustained cognitive deficits, bihemispheric axonal injury and neurodegeneration. Exp Neurol 2008; 213 (01) 84-92
  • 33 Pullela R, Raber J, Pfankuch T. , et al. Traumatic injury to the immature brain results in progressive neuronal loss, hyperactivity and delayed cognitive impairments. Dev Neurosci 2006; 28 (4-5): 396-409
  • 34 Cantor JB, Gordon WA, Schwartz ME, Charatz HJ, Ashman TA, Abramowitz S. Child and parent responses to a brain injury screening questionnaire. Arch Phys Med Rehabil 2004; 85 (04) (Suppl. 02) S54-S60
  • 35 Gordon WA, Brown M, Sliwinski M. , et al. The enigma of “hidden” traumatic brain injury. J Head Trauma Rehabil 1998; 13 (06) 39-56
  • 36 Gordon WA, Haddad L, Brown M, Hibbard MR, Sliwinski M. The sensitivity and specificity of self-reported symptoms in individuals with traumatic brain injury. Brain Inj 2000; 14 (01) 21-33
  • 37 Panayiotou A, Jackson M, Crowe SF. A meta-analytic review of the emotional symptoms associated with mild traumatic brain injury. J Clin Exp Neuropsychol 2010; 32 (05) 463-473
  • 38 Whittaker R, Kemp S, House A. Illness perceptions and outcome in mild head injury: a longitudinal study. J Neurol Neurosurg Psychiatry 2007; 78 (06) 644-646
  • 39 Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths 2002–2006. Atlanta, GA: Centers for Disease Control and Prevention National Center for Injury Prevention and Control; 2010
  • 40 Lazarsfeld PF, Henry NW. Latent Structure Analysis. Boston, MA: Houghton Mifflin Co.; 1968
  • 41 Muthén B. Latent variable analysis. In: Kaplan D. , ed. The Sage Handbook of Quantitative Methodology for the Social Sciences. Thousand Oaks, CA: Sage Publications; 2004: 345-368
  • 42 Rasmussen ER, Neuman RJ, Heath AC, Levy F, Hay DA, Todd RD. Replication of the latent class structure of Attention-Deficit/Hyperactivity Disorder (ADHD) subtypes in a sample of Australian twins. J Child Psychol Psychiatry 2002; 43 (08) 1018-1028
  • 43 McLachlan G, Peel D. Finite Mixture Models. New York: Wiley; 2000
  • 44 Celeux G, Soromenho G. An entropy criterion for assessing the number of clusters in a mixture model. J Classif 1996; 13 (02) 195-212
  • 45 Clark SL, Muthén B. Relating latent class analysis results to variables not included in the analysis. 2009 . Available at: www.statmodel.com/download/relatinglca.pdf
  • 46 Asparouhouv T, Muthen B. Wald test of mean equality for potential latent class predictors in mixture modeling. 2007 . Available at: http://www.statmodel.com/download/MeanTest1.pdf
  • 47 Muthén B. Should substance use disorders be considered as categorical or dimensional?. Addiction 2006; 101 (Suppl. 01) 6-16
  • 48 Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med 2003; 13 (04) 222-229
  • 49 Lovell MR, Iverson GL, Collins MW, McKeag D, Maroon JC. Does loss of consciousness predict neuropsychological decrements after concussion?. Clin J Sport Med 1999; 9 (04) 193-198
  • 50 Gavett BE, Stern RA, Cantu RC, Nowinski CJ, McKee AC. Mild traumatic brain injury: a risk factor for neurodegeneration. Alzheimers Res Ther 2010; 2 (03) 18-21
  • 51 McKee AC, Cantu RC, Nowinski CJ. , et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol 2009; 68 (07) 709-735
  • 52 Hux K, Bush E, Zickefoose S, Holmberg M, Henderson A, Simanek G. Exploring the study skills and accommodations used by college student survivors of traumatic brain injury. Brain Inj 2010; 24 (01) 13-26
  • 53 Ylvisaker M, Turkstra LS, Coelho C. Behavioral and social interventions for individuals with traumatic brain injury: a summary of the research with clinical implications. Semin Speech Lang 2005; 26 (04) 256-267