Concussion Symptom Inventory: An Empirically Derived Scale for Monitoring Resolution of Symptoms Following Sport-Related Concussion

Department of Neurology, Loyola University Medical Center, Chicago, Maywood, IL 60611, USA.
Archives of Clinical Neuropsychology (Impact Factor: 1.99). 07/2009; 24(3):219-29. DOI: 10.1093/arclin/acp025
Source: PubMed


Self-report post-concussion symptom scales have been a key method for monitoring recovery from sport-related concussion, to assist in medical management, and return-to-play decision-making. To date, however, item selection and scaling metrics for these instruments have been based solely upon clinical judgment, and no one scale has been identified as the "gold standard". We analyzed a large set of data from existing scales obtained from three separate case-control studies in order to derive a sensitive and efficient scale for this application by eliminating items that were found to be insensitive to concussion. Baseline data from symptom checklists including a total of 27 symptom variables were collected from a total of 16,350 high school and college athletes. Follow-up data were obtained from 641 athletes who subsequently incurred a concussion. Symptom checklists were administered at baseline (preseason), immediately post-concussion, post-game, and at 1, 3, and 5 days post-injury. Effect-size analyses resulted in the retention of only 12 of the 27 variables. Receiver-operating characteristic analyses were used to confirm that the reduction in items did not reduce sensitivity or specificity. The newly derived Concussion Symptom Inventory is presented and recommended as a research and clinical tool for monitoring recovery from sport-related concussion.

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    • "Memory deficits and other cognitive problems are associated with mTBI, which is often alternatively referred to as concussion (Randolph et al., 2009). The literature on the recovery from concussion suggests that the duration of symptoms usually is from 7 to 10 days (McCrory et al., 2005). "
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    ABSTRACT: Memory deficits and other cognitive symptoms frequently associated with mTBI are commonly thought to resolve within 7-10 days. This generalization is based principally on observations made in individuals who are in the unstressed environmental conditions typical of a clinic and so does not consider the impact of physiologic, environmental, or psychological stress. Normobaric hypoxic stress can be generated with normal mean sea level (MSL) air, which is about 21% oxygen (O2) and 78% nitrogen (N), by reducing the percentage of O2 and increasing the percentage of N so that the resultant mixed-gas has a partial pressure of O2 approximating that of specified altitudes. This technique was used to generate normobaric hypoxic equivalents of 8,000, 12,000, and 14,000 feet above MSL in a group of 36 volunteers with a mTBI history and an equal number of controls matched on the basis of age, gender, tobacco smoking consumption, weight, height, and body mass index. Short-term visual memory was tested using the Matching to Sample (M2S) subtest of the BrainCheckers analog of the Automated Neuropsychological Assessment Metrics. Although there were no significant differences in M2S performance between the two groups of subjects at MSL, with increased altitude, the mTBI group performance was significantly worse than that of the control group. When the subjects were returned to MSL, the difference disappeared. This finding suggests that the "hypoxic challenge" paradigm developed here has potential clinical utility for assessing the effects of mTBI in individuals who appear asymptomatic under normal conditions.
    Frontiers in Neurology 04/2013; 4:41. DOI:10.3389/fneur.2013.00041
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    • "Currently, there is no universally accepted set of symptoms required to be present in order for a patient to be diagnosed with a concussion. Rather, there is a wide range of telltale symptoms that may occur as a consequence of a concussion, which include headache, nausea, vomiting, dizziness, fatigue, abnormal sleeping patterns, drowsiness, and more (Randolph et al., 2009; Ledic et al., 2012; Slobounov et al., 2012). The pursuit for a comprehensive set of defining symptoms remains to be an area of intense investigation. "
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    ABSTRACT: Mild traumatic brain injuries (mTBI) have been associated with long-term cognitive deficits relating to trauma-induced neurodegeneration. These long-term deficits include impaired memory and attention, changes in executive function, emotional instability, and sensorimotor deficits. Furthermore, individuals with concussions show a high co-morbidity with a host of psychiatric illnesses (e.g., depression, anxiety, addiction) and dementia. The neurological damage seen in mTBI patients is the result of the impact forces and mechanical injury, followed by a delayed neuroimmune response that can last hours, days, and even months after the injury. As part of the neuroimmune response, a cascade of pro- and anti-inflammatory cytokines are released and can be detected at the site of injury as well as subcortical, and often contralateral, regions. It has been suggested that the delayed neuroinflammatory response to concussions is more damaging then the initial impact itself. However, evidence exists for favorable consequences of cytokine production following traumatic brain injuries as well. In some cases, treatments that reduce the inflammatory response will also hinder the brain's intrinsic repair mechanisms. At present, there is no evidence-based pharmacological treatment for concussions in humans. The ability to treat concussions with drug therapy requires an in-depth understanding of the pathophysiological and neuroinflammatory changes that accompany concussive injuries. The use of neurotrophic factors [e.g., nerve growth factor (NGF)] and anti-inflammatory agents as an adjunct for the management of post-concussion symptomology will be explored in this review.
    Frontiers in Cellular Neuroscience 12/2012; 6:58. DOI:10.3389/fncel.2012.00058 · 4.29 Impact Factor
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    • "In Rasch analysis one generally needs at least 10 observations per rating category. Second, in an earlier study of a different concussion symptom checklist involving 641 participants (Randolph et al., 2009) unstable item parameter estimates were obtained with Likert item scaling. As mentioned, items on the PCSQ are reflective of psychological, cognitive, somatic, and infrequency symptoms. "
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    ABSTRACT: The Postconcussive Symptom Questionnaire (PCSQ; Lees-Haley, 1992 ) is purported to measure four constructs. These include psychological, cognitive, somatic, and infrequency (i.e., items intended to reflect negative impression management) symptoms. The utility and validity of Postconcussive Syndrome (PCS) as a diagnostic condition continues to be debated. To this end, examining the instruments used to measure postconcussive symptoms can increase our understanding with respect to this issue. The aim of this study was to derive a revised PCSQ to target the core construct of subjective symptoms reported by persons with traumatic brain injury (TBI). A total of 133 people with mild to severe TBI completed the 45-item PCSQ. Items were scored dichotomously, as symptom present or absent. Rasch analysis, based on the mathematical model formulated by Rasch ( 1960 ), was used to derive the revised PCSQ. Misfitting and redundant items were removed and a second model containing 19 items was fitted. The revised PCSQ-19 had superior psychometric qualities; reliability was 0.81. The PCSQ-19 provides a more targeted, unidimensional assessment of subjective symptoms following brain injury. The findings also revealed information related to symptom hierarchy which can further our understanding of PCS.
    The Clinical Neuropsychologist 07/2012; 26(6):869-78. DOI:10.1080/13854046.2012.702789 · 1.72 Impact Factor
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