Rivermead Post Concussion Symptoms Questionnaire (RPQ) Scoring for Post-Concussion Syndrome
According to the World Health Organization (WHO), post-concussion syndrome is defined as the presence of 3 or more symptoms after a head injury, including headache, dizziness, fatigue, irritability, difficulty concentrating, memory impairment, insomnia, and reduced stress tolerance. 1
Understanding the RPQ Structure
The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is divided into two parts:
- RPQ3: The first three items (headaches, dizziness, nausea) 2
- RPQ13: The remaining 13 items that assess other post-concussion symptoms 2
Diagnostic Criteria for Post-Concussion Syndrome
Symptom Count Requirements
- For RPQ3 and RPQ13 combined: A patient must report 3 or more symptoms with a severity rating above 0 to meet criteria for post-concussion syndrome 1
- The RPQ consists of 16 symptoms associated with concussion that are assessed on a severity scale from 0 to 4 based on subjective symptoms at the time of administration 1
Duration Requirements
Different diagnostic frameworks specify varying duration requirements:
- World Health Organization (WHO): 3 or more symptoms after head injury (no specific duration requirement) 1
- DSM-IV: 3 or more symptoms persisting for 3 months 1
- Recent clinical approach: Persistent symptoms lasting 1-6 weeks after concussion 1
Important Considerations When Using the RPQ
- Psychometric limitations: Research shows that the RPQ should not be used as a single summated score as the 16 items do not measure the same underlying construct 2
- Recommended approach: Use RPQ-3 and RPQ-13 as separate scales for more accurate assessment 2
- Test-retest reliability: RPQ-13 (r=0.89) and RPQ-3 (r=0.72) demonstrate good reliability when used as separate scales 2
Clinical Significance of RPQ Scores
- Patients meeting criteria for post-concussion syndrome typically have significantly higher RPQ scores (mean 19.1) compared to those without the syndrome (mean 1.2) 3
- Higher RPQ scores at baseline are associated with:
Risk Factors for Persistent Post-Concussion Symptoms
Several factors are associated with prolonged symptoms and worse outcomes:
- Female gender 1
- Previous psychiatric history 1
- Glasgow Coma Scale score <15 1
- Assault as injury mechanism 1
- Alcohol intoxication at time of injury 1
- Loss of consciousness 1
- Lack of recall of receiving brain injury information from the ED 1
Common Pitfalls in Assessment
- Symptom attribution errors: Some symptoms may be present at baseline (e.g., concentration difficulties in patients with ADHD) and should not be attributed solely to the concussion 1
- Response bias: Consider using modified versions of the RPQ that include validity indicators to detect atypical symptom reporting 5
- Multifactorial etiology: Both physiological and psychological factors contribute to persistent symptoms 6
- Incomplete assessment: Failure to consider pre-morbid, injury-related, and post-morbid factors can lead to inaccurate diagnosis 6