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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    • "In an effort to evaluate postconcussion symptoms and other sequelae of concussion, a variety of tools and techniques have been developed and implemented in sports concussion management programs, including sideline evaluations (McCrea, 2001; McCrea et al., 1998), neuropsychological testing (Echemendia, Putukian, Mackin, Julian, & Shoss, 2001; Maroon et al., 2000), balance/postural-stability testing (McCrea et al., 2003; Riemann & Guskiewicz, 2000), and symptom evaluation scales (Eyres, Carey, Gilworth, Neumann, & Tennant, 2005; Lovell et al., 2006; Piland, Motl, Guskiewicz, McCrea, & Ferrara, 2006; Randolph et al., 2009). Despite the potential limitations associated with the use of symptom evaluation scales— primarily, athletes' possible motivation to minimize existing symptoms—these subjective measures are readily used at all levels of sports participation to assess and monitor recovery following concussion. "
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    ABSTRACT: Self-report measures such as the Post-Concussion Symptom Scale (PCSS) are frequently used during baseline and postconcussion testing to evaluate athletes' symptom profiles. However, the common approach of evaluating the total symptom score and/or symptom clusters may not allow for a complete understanding of the nature of athletes' symptom reporting patterns. The primary objective of this study was to apply three "global indices of distress" variables, derived from the Symptom Checklist-90-Revised (SCL-90-R) framework, to the PCSS at baseline and postconcussion. We aimed to evaluate the utility of these symptom indices in relation to four PCSS symptom clusters and the total PCSS symptom score. Participants included college athletes evaluated at baseline (N = 846) and postconcussion (N = 86). Athletes underwent neuropsychological testing at both time points, including completion of the PCSS and a paper/pencil and computerized test battery. Eight symptom indices were derived from the PCSS, and a postconcussion neurocognitive composite score was calculated. Results showed that there were significant mean increases from baseline to postconcussion on four of the eight symptom indices evaluated. Furthermore, a significant proportion of athletes showed no change from baseline to postconcussion when evaluating the total symptom score, but showed at least a one standard deviation increase in symptom reporting from baseline to postconcussion when evaluating at least one other symptom index (i.e., a global index of distress or symptom cluster). Finally, the three global indices of distress variables, two of the four symptom clusters, and the total symptom score significantly predicted a postconcussion neurocognitive composite score, such that greater postconcussion symptoms were associated with lower postconcussion neurocognitive performance. These findings suggest that, in addition to evaluating the postconcussion total symptom score, there may be value in examining more specific symptom indices such as the global indices of distress variables and symptom clusters.
    Full-text · Article · Aug 2015 · Journal of Clinical and Experimental Neuropsychology
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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.
    Full-text · Article · Apr 2013 · Frontiers in Neurology
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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.
    Full-text · Article · Dec 2012 · Frontiers in Cellular Neuroscience
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