Predicting outcome following mild traumatic brain injury: protocol for the longitudinal, prospective, observational Concussion Recovery (CREST) cohort study

Aleksandra Karolina Gozt, Sarah Claire Hellewell, Jacinta Thorne, Elizabeth Thomas, Francesca Buhagiar, Shaun Markovic, Anoek Van Houselt, Alexander Ring, Glenn Arendts, Ben Smedley, Sjinene Van Schalkwyk, Philip Brooks, John Iliff, Antonio Celenza, Ashes Mukherjee, Dan Xu, Suzanne Robinson, Stephen Honeybul, Gill Cowen, Melissa LicariMichael Bynevelt, Carmela F Pestell, Daniel Fatovich, Melinda Fitzgerald

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


INTRODUCTION: Mild traumatic brain injury (mTBI) is a complex injury with heterogeneous physical, cognitive, emotional and functional outcomes. Many who sustain mTBI recover within 2 weeks of injury; however, approximately 10%-20% of individuals experience mTBI symptoms beyond this 'typical' recovery timeframe, known as persistent post-concussion symptoms (PPCS). Despite increasing interest in PPCS, uncertainty remains regarding its prevalence in community-based populations and the extent to which poor recovery may be identified using early predictive markers.

OBJECTIVE: (1) Establish a research dataset of people who have experienced mTBI and document their recovery trajectories; (2) Evaluate a broad range of novel and established prognostic factors for inclusion in a predictive model for PPCS.

METHODS AND ANALYSIS: The Concussion Recovery Study (CREST) is a prospective, longitudinal observational cohort study conducted in Perth, Western Australia. CREST is recruiting adults aged 18-65 from medical and community-based settings with acute diagnosis of mTBI. CREST will create a state-wide research dataset of mTBI cases, with data being collected in two phases. Phase I collates data on demographics, medical background, lifestyle habits, nature of injury and acute mTBI symptomatology. In Phase II, participants undergo neuropsychological evaluation, exercise tolerance and vestibular/ocular motor screening, MRI, quantitative electroencephalography and blood-based biomarker assessment. Follow-up is conducted via telephone interview at 1, 3, 6 and 12 months after injury. Primary outcome measures are presence of PPCS and quality of life, as measured by the Post-Concussion Symptom Scale and the Quality of Life after Brain Injury questionnaires, respectively. Multivariate modelling will examine the prognostic value of promising factors.

ETHICS AND DISSEMINATION: Human Research Ethics Committees of Royal Perth Hospital (#RGS0000003024), Curtin University (HRE2019-0209), Ramsay Health Care (#2009) and St John of God Health Care (#1628) have approved this study protocol. Findings will be published in peer-reviewed journals and presented at scientific conferences.


Original languageEnglish
Article numbere046460
Number of pages15
JournalBMJ Open
Issue number5
Publication statusPublished - 13 May 2021


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