Development and Validation of a Model Predicting Post-Traumatic Headache Six Months After a Motor Vehicle Collision in Adults Cancelliere C, Boyle E3, Côté P, Holm LW, Salmi LR, Cassidy JD

Development and Validation of a Model Predicting PostTraumatic Headache Six Months After a Motor Vehicle Collision in Adults

Cancelliere C1,2, Boyle E3, Côté P1,2,4.5,6 , Holm LW6, Salmi LR5,6, Cassidy JD4

1Ontario Tech University, 2Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 3University of Southern Denmark, 4University of Toronto, 5Research Chair in Disability Prevention and Rehabilitation, 6Ontario Tech University, 7Karolinska Institutet, 8ISPED/Bordeaux School of Public Health, University of Bordeaux

Abstract

Importance: The prognosis of post-traumatic headache is poorly understood.

Objective: To develop and validate a prognostic model to predict the presence of post-traumatic headache six months after a traffic collision in adults with incident post-traumatic headache.

Design: Secondary analyses of adults with incident post-traumatic headache injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada (development cohort); and between January 2004 and January 2005 in Sweden (validation cohort).

Setting: The Saskatchewan cohort (development) was population-based (N = 4162). The Swedish cohort (validation) (N = 379) were claimants from two insurance companies covering 20 % of cars driven in Sweden in 2004.

Participants: All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized >2 days, lost consciousness >30 min, or reported headache <3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80 %.

Predictors: Baseline sociodemographic, pre-injury, and injury factors.

Outcome: Self-reported headache pain intensity ≥3 (numerical rating scale) six months after injury. Results: Both cohorts were predominantly female (69.7 % in Saskatchewan, 65.2 % in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, work status, headache pain intensity, symptoms in arms or hands, dizziness or unsteadiness, stiffness in neck, pre-existing headache, and lower recovery expectations. With a positive score (i.e., ≥0.75 probability), the model can rule in the presence of post-traumatic headache at six months (development: specificity = 99.8 %, 95 % CI 99.5 %-99.9 %; sensitivity = 1.6 %, 95 % CI 1.0 %-2.6 %; positive likelihood ratio (LR+) = 8.0, 95 % CI 2.7-24.1; negative likelihood ratio (LR-) = 1.0, 95 % CI 1.0-1.0; validation: specificity = 95.5 %, 95 % CI 91.1 %-97.8 %; sensitivity = 27.2 %, 95 % CI 20.4 %-35.2 %); LR+ = 6.0, 95 % CI 2.8-13.2; LR- = 0.8, 95 % CI 0.7-0.8).

Conclusions and relevance: Clinicians can collect patient information on the eight predictors of our model to identify patients that will report ongoing posttraumatic headache six months after a traffic collision. Future research should focus on selecting patients at high risk of poor outcomes (using our model) for inclusion in intervention studies, and determining effective interventions for these patients.

Originally published in Accident Analysis & Prevention, 2020 Jul;142:105580. Epub 2020 May 20.

Reproduced with permission from Elsevier.

Access Online: https://doi.org/10.1016/j.aap.2020.105580