Litigation and persistent post-concussion syndrome (PPCS)

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Abstracts from the 18th Annual Meeting

correlate more highly than did the clinical scales. Stepwise hierarchical regression analyses indicated that, overall, the content scales demonstrate incremental validity relative to clinical scales for both males and females. In contrast, the clinical scales demonstrated less incremental validity relative to the content scales for both genders. Implication of these findings regarding MMPI-2 interpretation and future research directions with a brain-injured population are discussed.

Paniak, C., Toiler-Lobe, G., Durand, A., & Nagy, J. Litigation and Persistent Post-Concussion Syndrome (PPCS). Most research shows that litigation is associated with poorer outcomes after mild traumatic brain injury (MTBI). The purpose of the present study was to evaluate this phenomenon in a longitudinal sample that had received specialized treatment after MTBI. Participants were 110 adult MTBI survivors who were drawn from consecutive admissions to two hospital emergency wards and seen within 3 weeks of injury. They were invited to participate in a study of treatment for MTBI. The treatment essentially involved a 1-hour meeting with the first author to: (a) discuss any questions or concerns about the injury, (b) go over the National Head Injury Foundation's "The Unseen Injury: Minor Head Trauma" brochure, (c) be provided with guidance on how to cope with any symptoms, and (d) be reassured of probable good recovery. Participants were also interviewed and administered standardized questionnaires. At 12 to 13 months post-injury, participants were again interviewed and administered the same questionnaires. Data analyses for the present study focused on investigating the association of litigation with outcomes 12-13 months post-injury. Litigation was broadly defined as seeking or receiving financial compensation via any mechanism (i.e., sick pay, Worker's Compensation or insurance benefits, or a lawsuit). Fifteen of the 110 participants (13.6%) were considered to have persisting disability (i.e., PPCS), as defined by failure to return to their pre-injury vocational functioning by 1 year post-injury. Thirteen of the 15 PPCS patients (87%) were involved in litigation, whereas this was the case for only 23 of 95 (24%) of those without PPCS, X 2 (3) = 35.80, p < .001. The strong association of litigation with PPCS could not readily be accounted for by other factors, as litigants and non-litigants did not differ on age, sex, socioeconomic status, post-traumatic amnesia duration, overall bodily injury severity (Injury Severity Score), number of previous MTBI's, history of psychological/psychiatric treatment, or reported usual alcohol/drug consumption. The association of litigation with outcome was then examined in other ways. Litigants took a median of 180 days to return to full-time pre-injury vocational activity, versus a median of only 3 days for non-litigants, Mann Whitney U = 369.00, p < .001. Litigants reported no statistically significant improvement from baseline to 1 year on six scores from a TBI symptom questionnaire, T. Kay et al.'s Problem Checklist. Non-litigants reported statistically significant improvements on all six scores. Our results confirm the association of litigation with poorer outcomes, even in a treated MTBI sample; the longitudinal design allows the demonstration of dissociations over time between litigants and non-litigants.

Pinkston, J. B., Gouvier, W. D., & Santa Maria, M. P. Test Classification Failure in Mild Head Injury: A Base Rate Analysis. Individuals who experience a mild head injury (MHI) sometimes develop a constellation of symptoms referred to as post concussion syndrome (PCS). However, some mildly head injured persons do not report these symptoms and some non-head injured individuals do. Controversy exists as to what these symptoms represent and what their ultimate causes are. For practical purposes, it would be beneficial to be able to accurately diag-