Because of this 3-month consensus that exists in the literature, researchers tend to superimpose a three month time frame upon the ICD-10 criteria, since that criteria set makes no mention of a time frame. An example of this can be seen in the paper by Boake an colleagues (2005), which examined the degree of agreement between ICD-10 and DMS-IV criteria for the post-concussive diagnoses.

Given all of this information, when someone states that “post-concussion syndrome” is present in someone less than three months post-injury, the first question should be which criteria are being used. This is frequently met by a blank stare since many people are unaware of the actual criteria. If DSM-IV criteria for postconcussive disorder are used, then the time frame is three months or more. If the ICD-10 postconcussional syndrome criteria are used, one can technically use any time frame since the criteria do not mention a time frame. But doing so reflects a misunderstanding of the consensus in the research literature showing a three month symptom resolution date for most people. “Post concussion syndrome” is used to describe those individuals who do not report full symptom recovery past the time when recovery would normally be expected. In the acute or subacute phase, the presence of symptoms can be a normal experience. In fact, empirically validated treatments (Mittenberg et al., 1993, 1996, 2001) to reduce the occurrence of persisting symptoms are based on normalizing early symptoms and not pathologizing them. Referring to the normal experience of symptoms in the acute or subacute post-injury phase as a “syndrome” would not be consistent with this treatment model.

CHECKING SOURCES

It is unclear what source various individuals rely on when they use less than a three month time frame for “post concussion syndrome.” These days, one of the most popular sources for information is Wikipedia, the encyclopedia that anyone can edit. At the time this article was originally written (12/27/08) "the Wikipedia entry for post-concussion syndrome” stated the following:

”A diagnosis may be made when symptoms resulting from concussion last for more than three months after the injury,^[4] or it may be made starting within a week^[5] or ten days of trauma.^[6]” While the first part of the statement is correct, let us examine the references used to support the latter part of the statement. An important theme that will continue to recur on MTBIFacts.com is the need to check the references to determine the primary source in the peer-reviewed scientific literature that the information is based on. With that in mind, reference number five was:

Legome E. 2006. Postconcussion syndrome at eMedicine.com. The reference states the article was accessed on January 1, 2007. The eMedicine article states that “Confusion exists in the literature, with some authors defining it as symptoms of at least 3 months duration, while others define it as symptoms appearing within the first week.” However, no references were provided to identify the source(s) for a one week criteria threshold. Therefore, the reference to the eMedicine article was not helpful.

Reference number six is Schnadower et al. (2007). That reference states the following: “Postconcussion syndrome has been defined as the persistence beyond 7–10 days of the injury of any one of the following symptoms not present before injury:…” (p. 261). A number of symptoms are then listed. The reference provided is DSM-IV and McCrory et al. (2005). Thus, the Schnadower article is not the primary source of the information. The DSM-IV reference was likely only provided as the source of the symptoms since DSM-IV criteria states the symptoms must be present for three months. That leaves us with the McCrory reference.