Comparison of ICD-10 and DSM-IV Criteria for Postconcussion Syndrome/Disorder

Comparison of ICD-10 and DSM-IV Criteria for Postconcussion Syndrome/Disorder

Stephen R. McCauley1,2,3,4, Elisabeth A. Wilde1,2,4,5, Emmy R. Miller6, Claudia S. Robertson7,
James J. McCarthy8,9, and Harvey S. Levin1,2,3,4,7


Little is known about how the existing diagnostic criteria for postconcussion syndrome/disorder (PCS/PCD) perform in the actual clinical diagnosis of this condition. Both clinical and research evidence to guide diagnosis of PCS/PCD are fraught with inconsistencies. The comparability of studies of patients with PCS/PCD following mild traumatic brain injury (mTBI) is frequently hampered by nonuniformity of symptoms and additional criteria used to diagnose the disorder. This limitation may also contribute to the inconsistency of findings regarding prevalence and outcome following mTBI. Although the International Classification of Diseases 10th Edition (ICD-10) has clinical and research cri- teria for PCS, and the Diagnostic and Statistical Manual 4th Edition (DSM-IV) included provisional criteria for postconcussion disorder (PCD), few studies appear to employ these criteria sets. Consequently, little is known about how these diagnostic criteria perform and which one, if any, is preferred. Exploring this issue, 101 participants with mTBI (ages 18-50 years) were recruited from consecutive admissions to two Level-1 trauma centers in Houston, Texas with outcome measures including: SF-12, Rivermead Post Concussion Symptoms Questionnaire (RPSQ), Center for Epidemiologic Studies-Depression scale (CES-D), and the Connor-Davidson Resilience Scale (CD-RISC). Measures of attention and memory included the Symbol-Digit Modalities Test, Verbal Selec- tive Reminding Test, and the Brief Visuospatial Memory Test-Revised. Preva- lence rates for diagnosing PCS/PCD varied widely among the three criteria sets (ICD-10 clinical, ICD-10 research, DSM-IV) and scheduled study occasions. A comparison of prevalence rates at these time points showed substantial dissimilarity in the percentage of participants meeting criteria for PCS/PCD (e.g., ICD-10 clinical = 60.4%; ICD-10 research = 33.7%, and DSM-IV = 27.7% at one week vs. 30.4%, 20.7%, and 13.0%, respectively at three months). In addition, parallel analyses were con- ducted in which participants with PCD/PCS were compared to those without the disorder. Those with PCS/PCD reported significantly lower general mental health, higher PCS symptom severity, and higher levels of depressive features using the ICD-10 clinical and DSM-IV criteria. Fewer significant differences were found using the ICD-10 research criteria; none reached significance at one week postinjury. Par- ticipants meeting vs. not meeting ICD-10 clinical PCS criteria were compared on attention and memory and no significant differences were found for any measure at any study occasion. Although PCS/PCD prevalence rates varied widely, all three sets appear to identify a subgroup of participants with elevated symptom severity. The ICD-10 research criteria perform differently from the other sets and may be rel- atively less sensitive in the first week postinjury.

1 Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
2 Department of Neurology, Baylor College of Medicine, Houston, Texas
3 Department of Pediatrics, Baylor College of Medicine, Houston, Texas
4 Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
5 Department of Pediatric Radiology, Baylor College of Medicine, Houston, Texas
6 Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
7 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
8 Department of Emergency Medicine, University of Texas Medical School, Houston, Texas
9 Department of Emergency Medicine, Memorial-Hermann Hospital, Houston, Texas

Corresponding author:
Stephen R. McCauley, PhD
Baylor College of Medicine 6501 Fannin St., NB 126, Houston, Texas 77030 E-mail: voice: 713-798-7479;
fax: 713-798-6898


mild traumatic brain injury; postconcussion symptoms; DSM-IV; ICD-10.

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