Abstract
Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. This cross-sectional study included a large sample (age range: 11–18) of girls (n = 21,923) and boys (n = 26,556) without a recent concussion who completed the Post-Concussion Symptom Scale at preseason baseline. Endorsements rates varied substantially by definition, health history, and current health issues. The most lenient definition (i.e., a single mild symptom) was endorsed by most participants (54.5% of boys/65.3% of girls). A large portion of participants with pre-existing mental health problems (42.7% of boys/51.5% of girls), current moderate psychological distress (70.9% of boys/72.4% of girls), and insufficient sleep prior to testing (33.4% of boys/47.6% of girls) endorsed symptoms consistent with mild ICD-10 postconcussional syndrome; whereas participants with no current or prior health problems rarely met this definition (1.6% of boys/1.6% of girls). The results illustrate the tremendous variability in the case definitions of persistent symptoms and the importance of harmonizing definitions across future studies.
Highlights
The typical recovery time from a sport-related concussion in children and adolescents ranges from a few days to 1 month [1,2,3,4,5,6,7], but many youth have symptoms that persist for considerably longer than 1 month [8,9,10,11,12,13]
The most lenient operational definition for persistent symptoms was a single symptom on the Post-Concussion Symptom Scale (PCSS), which was endorsed at the highest frequency for all participant categories
The moderate ICD-10 postconcussional syndrome definition was the least commonly met definition across groups, with rates for boys ranging from 49.6% among those with past psychiatric treatment and moderate current psychological distress to 0.1% among those with no pre-existing conditions or current health issues and rates for girls ranging from 57.3% among those with attention-deficit/hyperactivity disorder (ADHD) and moderate current psychological distress to 0.2% among those with no pre-existing conditions or current health issues
Summary
The typical recovery time from a sport-related concussion in children and adolescents ranges from a few days to 1 month [1,2,3,4,5,6,7], but many youth have symptoms that persist for considerably longer than 1 month [8,9,10,11,12,13]. Some studies define recovery as being completely asymptomatic or having complete symptom resolution [11, 13, 14] and having a score of zero on a symptom questionnaire [15,16,17], endorsing a single symptom during a post-injury evaluation meets the threshold for having persistent symptoms, not being recovered, or both. Other studies have attempted to compare retrospective ratings of preinjury symptoms to post-injury symptoms. The large Canadian “5P” multi-center study defined persistent symptoms as having 3 or more symptoms endorsed as greater, to any degree, than their retrospective preinjury symptom rating [9]. Other studies examine symptom reports in combination with other clinical data, such as by requiring resolution of symptoms [19] or being symptom-free at rest and with exertion [17], in combination with results of balance testing, neurocognitive performances, and normal resumption of academic activities
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