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. "
[Show abstract][Hide abstract]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
"Self-reported concussion symptoms were quantified using a graded concussion symptom inventory including 11 of 12 items (fatigue and drowsiness were combined into one item) from the Concussion Symptom Inventory (CSI)  plus three additional items regarding irritability, sadness and poor sleep which are not captured in the CSI but are known sequelae of concussion . Subjects verbally rated the degree of symptoms they were experiencing. "
[Show abstract][Hide abstract]ABSTRACT: To describe differences in outpatient follow-up and academic accommodations received by children with and without persistent post-concussion symptoms (PPCS) after emergency department (ED) evaluation. It was hypothesized that children with PPCS would have more outpatient visits and receive academic accommodations more often than children without PPCS and that follow-up would be positively associated with receiving accommodations.
Children aged 8-18 years with acute (≤6hours) concussion at time of presentation to a paediatric ED were enrolled in an observational study. Outcomes were assessed through a telephone survey 30 days after injury.
Of 234 enrolled participants, 179 (76%) completed follow-up. PPCS occurred in 21%. Only 45% of subjects had follow-up visits after ED discharge. Follow-up visit rates were similar for those with and without PPCS (58% vs. 41%, respectively; p = 0.07). Children with PPCS missed twice as many school days as those without (3 vs. 1.5; p < 0.001), but did not differ in receiving academic accommodations (36% vs. 53%; p = 0.082). Outpatient follow-up was associated with receiving academic accommodations (RR = 2.2; 95% CI = 1.4-3.5).
Outpatient follow-up is not routine for concussed children. Despite missing more school days, children with PPCS do not receive academic accommodations more often. Outpatient follow-up may facilitate academic accommodations.
"It is possible to define concussion as a traumatic insult capable of provoking an acceleration-deceleration phenomenon within the skull (Barth et al., 2001). From a clinical point of view, concussion is not necessarily accompanied by loss of consciousness and is associated with various physical (headache, equilibrium, vision disturbances, etc.), cognitive (memory, concentration, etc.), emotional (behaviour) and sleep alterations (Gosselin et al., 2009; Hunt & Asplund, 2010; Randolph et al., 2009). These symptoms are included in the well known post-concussive syndrome and can affect, to various degrees, everyday life, resolving spontaneously within 7-10 days post-injury, in the majority of cases. "