TBI
Atharv C. Patwardhan, MD
Resident Physician
Medical College of Wisconsin-Affiliated Hospitals
Milwaukee, Wisconsin, United States
Mayuresh C. Vernekar, BS
Medical Student
Chicago Medical School at Rosalind Franklin University of Medicine & Science
North Chicago, Illinois, United States
Bharathi Swaminathan, MD
Principal Investigator
Chicago Medical School at Rosalind Franklin University of Medicine & Science; FHCC-Lovell VA
North Chicago, Illinois, United States
Atharv C. Patwardhan, MD
Medical College of Wisconsin-Affiliated Hospitals
Milwaukee, Wisconsin, United States
A substantial proportion of CT-negative mTBI patients develop psychiatric sequelae despite the absence of acute radiologic or biomarker abnormalities. Recent studies demonstrate that cognitive-affective responses, such as perceived injustice or early trauma appraisal, strongly correlate with post-concussive symptoms, depression, and PTSD, compared to imaging or blood biomarkers. This study aims to synthesize recent evidence (2019–2025) on the predictive value of early self-appraisal for psychiatric outcomes after mTBI, with emphasis on CT-negative populations and standardized follow-up instruments.
Design:
PRISMA-ScR scoping review. Databases: PubMed, Embase, Scopus, PsycINFO, Cochrane CENTRAL (2019–present). Inclusion: human studies with mTBI/concussion; report of CT result and/or acute biomarker(s) within ~24–48h; psychiatric outcomes measured with validated tools at ≥30 days (e.g., RPQ, PCL-5, PHQ-9, GAD-7). We extracted study design, setting, cohort size, CT status, biomarker assay/timing/cutoffs, outcome instrument/timing, effect estimates, and reported modifiers (e.g., age, sex, psychiatric history, mechanism, substance use, sleep disruption, perceived injustice). Data were summarized narratively and in evidence tables; where feasible, outcomes were stratified by CT and biomarker status.
Results:
Across multiple cohorts, 20–25% of CT-negative mTBI patients developed PTSD or depression within 6 months. Large studies (e.g., TRACK-TBI) confirm that over half of CT-negative patients remain functionally impaired at 6 months. Biomarker studies show limited predictive value; paradoxically, very low GFAP levels have been linked to worse psychiatric outcomes, underscoring the primacy of psychosocial mechanisms. Early self-appraisal measures, including perceived injustice and perceived trauma severity, consistently predicted higher RPQ, PCL-5, PHQ-9, and GAD-7 scores at 30–90 days.
Conclusions:
Early trauma self-appraisal is a robust, independent predictor of psychiatric burden after mTBI, particularly in CT-negative and biomarker-low patients. Routine incorporation of brief appraisal questions and early symptom screening (RPQ, PCL-5, PHQ-9, GAD-7 at 30–60 days) could enable trauma-informed follow-up and targeted mental-health interventions in this high-risk but often overlooked population.
