Abstract
Classifying concussion in key subtypes according to presenting symptomatology at an early post-injury stage is an emerging approach that may allow prediction of clinical trajectories and delivery of targeted treatments. The Rivermead Post-concussion Symptoms Questionnaire (RPQ) is a simple, freely available, and widely used tool for assessment of the presence and severity of various post-concussion symptoms. We aimed to probe the prevalence among athletes of symptom classes associated with identified concussion phenotypes using the RPQ at baseline and acutely after a concussion. Participants of organized sports aged 12–30 years were baseline-assessed with the expectation that some would experience a concussion during the study period. Concussed athletes were re-assessed within 2 weeks of their injuries. The RPQ was supplemented with three specific questions and reworded for baseline assessment. A binomial test was used to contrast the prevalence of an attribute in the concussed cohort against the probability established by the baseline observation. Three thousand and eighty-eight athletes were baseline-assessed and eighty-nine were re-assessed post-concussion. All concussed athletes endorsed having some elevated symptoms in the RPQ, and such endorsements were more prevalent than those among normal athletes. Moderate-to-severe post-concussion symptoms of specific classes tended to be endorsed with few additional symptoms of other classes of similar intensities. Elevated symptoms detected with the RPQ within as short as 2 weeks after a concussion may help delineate patients' clinical subtypes and guide their treatment. Further refinement of symptom questionnaires and use of objective measures will be needed to properly populate the concussion subtype classification.
Highlights
Concussions are heterogeneous—there is a broad consensus among experts that a one-size-fits-all approach to post-concussion management is ineffective [1,2,3,4]
The six suggested profiles with partially overlapping symptoms are described as: [1] cognitive-fatigue, with symptoms of fatigue, decreased energy, non-specific headache, sleep disruption, or difficulty concentrating; [2] vestibular, with symptoms of dizziness, fogginess, nausea, feeling of being detached, or overstimulation in complex environments; [3] oculomotor, with symptoms of fatigue, distractibility, difficulties with visually based classes, pressure behind the eyes, or blurred or double vision; [4] anxiety/mood, with symptoms of anxiety, hypervigilance, feeling of being overwhelmed, sadness, or hopelessness; [5] post-traumatic migraine, with symptoms of headache with a pulsating quality associated with nausea, photosensitivity, or phonosensitivity; and [6] cervical, with symptoms of headache, neck pain, or numbness/tingling of the extremities
Among the six post-concussion symptom classes described by clinical and anecdotal evidence [5, 6, 11] and identifiable with the current implementation of the Rivermead Post-concussion Symptoms Questionnaire (RPQ), cognitive-fatigue-related symptoms were most prevalently endorsed by concussed athletes at all levels of severity
Summary
Concussions are heterogeneous—there is a broad consensus among experts that a one-size-fits-all approach to post-concussion management is ineffective [1,2,3,4]. Based on clinical and anecdotal evidence, it has been suggested that the six clinical phenotypes of concussion described below may be profiled according to symptoms observed within about 1 week post-concussion [5, 6]. We recognize that sleep disturbance is a condition that has emerged in the literature as affecting recovery from concussion [4, 10,11,12] and that it is considered to be a modifier in the recent update to this clinical profiling approach [6]. We will distinguish sleep disturbance as a symptom class associated with concussion not as characterizing a subtype of concussion
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
