Concussion Symptom Severity Research Articles

Progesterone and Estradiol Levels Associated with Concussion and Clinical Outcomes and Recovery in Female Athletes and Cadets.

Introduction: Female athletes are underrepresented in concussion research, and few studies have investigated associations of ovarian hormones with concussion outcomes. This study explored associations of concussion with levels and variability of progesterone, estradiol, and their ratio (P/E) and examined relationships of hormone levels with clinical measures and recovery after concussion in CARE Consortium female athletes and cadets.Methods: Female participants enrolled (n = 749) at pre-injury baseline. Participants with concussion (mean age 19.34 years; n = 130, 90 athletes, 40 non-athlete cadets) completed one or more visits at non-standardized times of day: immediately post-injury, 24-hours post-injury, upon initiating the return-to-play protocol (Init RTP), and seven days following unrestricted return-to-play (PRTP). Controls (mean age 19.85 years; n = 67, 61 athletes, 6 non-athlete cadets) completed similar visits. Linear mixed models and general linear models tested associations of hormone levels and/or variation with concussion status, symptoms, and recovery, controlling for self-reported birth control use at pre-injury baseline.Results: Female participants with concussion had higher progesterone levels relative to controls on average across all visits (mean difference (ln ng/mL) (standard error) MD = 0.26(0.08), t(193) = 3.03, p = 0.003). Those with concussion had elevated estradiol at 24 hours (MD = 0.27(0.09), t(506) = 3.04, p = 0.02), Init RTP (MD = 0.38(0.09), t(508) = 4.29, p < 0.001), and PRTP (MD = 0.30(0.09), t(515) = 3.25, p = 0.01) relative to pre-injury baseline, and compared to controls at Init RTP (MD = 0.35(0.12), t(429) = 2.78, p = 0.006). Concussed participants had a lower range of estradiol over 7-28 days than controls (B(SE) = -0.24(0.09), F(1,145) = 6.43, p = 0.01). Acutely after concussion, estradiol was positively associated with Brief Symptom Inventory Global Severity Index scores (B(SE) = 0.29(0.12), F(1,102) = 5.60, p = 0.02). No significant relationships were found between hormones and recovery.Conclusions: These results, which warrant further research, suggest ovarian hormones may be associated with concussion and psychological symptom severity post-concussion.

Identifying the ‘Miserable Minority’ Among Pediatric Patients Following Concussion

ObjectivesTo investigate whether there are empirically-detectable subgroups of concussion severity and recovery across three consecutive concussions, as well as to define risk factor and clinical assessment differences across subgroups. MethodsThe present study was a retrospective chart review of 202 adolescents 13.17 ± 1.99 years old who presented to a concussion specialty clinic within 30 days of injury for multiple injuries between 2019 and 2020. Participants included patients from a specialty clinic for two (n = 202) or three (n = 68) total concussions. Latent class analysis (LCA) was used to identify subgroups based upon concussion symptom severity and recovery time. Risk factors (sex, age at first injury, and histories of anxiety, depression, migraine, motion sickness, ocular dysfunction, and attention-deficit/hyperactivity disorder [ADHD] or learning disability [LD]) were compared across subgroups. ResultsA two-class solution yielded one group of 163 participants characterized by lower symptoms and shorter recovery times (80.7%, “normal”) and 39 participants (19.3%, “miserable minority”) characterized by higher symptoms and longer recovery times. Only female sex (OR = 4.91, p = 0.005) was a significant predictor of class membership. The miserable group presented for treatment nearly 4 days later (9.41 days) compared to the normal group (5.74 days) for the first injury, and almost 2 days later for the second injury (7.33 vs 5.26 days). ConclusionsApproximately 1 in 5 patients who presented to a concussion specialty clinic for a repeat concussion were classified in the miserable minority subgroup. This subgroup was characterized by markedly higher initial symptom burdens and over double the recovery time. Level of EvidenceRetrospective cohort study, Level III evidence.

Feasibility and Preliminary Effectiveness of an Online Meditation Intervention in Young Adults With Concussion History.

Mindfulness interventions (yoga, meditation) in traumatic brain injury populations show promising improvements ininjury outcomes. However, most studies include all injury severities and use in-person, general programming lacking accessibility and specificity to the nuance of concussion. Therefore, this study investigated the feasibility and preliminary effectiveness of an online, concussion-focused meditation intervention among young adults with a concussion history. Unblinded, single-arm, pilot intervention. Fifteen young adults aged 18 to 30 with a concussion history within the past 5years completed 10 to 20minutes per day of online, guided meditations for 6 weeks. Feasibility was assessed using the Feasibility of Intervention Measure. Concussion symptoms were measured using the Rivermead Post-Concussion Symptom Questionnaire, perceived stress the Perceived Stress Scale-10, and mindfulness the Five Facet Mindfulness Questionnaire. Descriptive statistics described the study sample and determined intervention adherence and feasibility. Paired sample t tests were used to examine preintervention/postintervention changes in concussion symptoms, perceived stress, and mindfulness, with descriptive statistics further detailing significant t tests. Fifteen participants were enrolled, and 12 completed the intervention. The majority completed 5+ days per week of the meditations, and Feasibility of Intervention Measure (17.4 [1.8]) scores indicated high feasibility. Concussion symptom severity significantly decreased after completing the meditation intervention (11.3 [10.3]) compared with before the intervention (24.5 [17.2]; t[11] = 3.0, P = .01). The number of concussion symptoms reported as worse than before their concussion significantly decreased after completing the meditation intervention (2.7 [3.9]) compared with before the intervention (8.0 [5.7]; t[11] = 3.7, P = .004). Postintervention, 83.33% (n = 10) reported lower concussion symptom severity, and 75.00% (n = 9) reported less concussion symptoms as a mild, moderate, or severe problem (ie,worse than before injury). Findings suggest positive adherence and feasibility of the meditation intervention, with the majority reporting concussion symptom improvement postintervention. Future research is necessary to expand these pilot findings into a large trial investigating concussion-specific meditation programming.

Athlete Fear Avoidance, Depression, and Anxiety Are Associated with Acute Concussion Symptoms in Athletes.

Background: Assessing sport-related concussions in athletes presents challenges due to symptom variability. This study aimed to explore the relationship between acute concussion symptoms and athlete fear avoidance, pain catastrophizing, depression, and anxiety. Anxiety and depression have previously been associated with the number of symptoms after a concussion, but no prior research has examined the possible link between athlete fear avoidance and acute concussion symptoms. Methods: Thirty-four collegiate athletes (mean age = 20.9 ± 1.8 years) were assessed within 48 h of a concussion using the Sport Concussion Assessment Tool 5, Athlete Fear Avoidance Questionnaire (AFAQ), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. Results: Results showed a significant association between the athlete fear avoidance and the number of concussion symptoms (r = 0.493, p = 0.003), as well as depression and anxiety measured by HADS (r = 0.686, p < 0.001). Athlete fear avoidance and HADS scores were predictors of symptom severity, explaining 41% of the variance (p = 0.001). Athletes with higher fear avoidance tended to report more symptoms post concussion. Conclusions: This study underscores the link between athlete fear avoidance, anxiety, depression, and the severity of concussion symptoms. Administering the AFAQ to assess athlete fear avoidance at the initial assessment of a concussion may be helpful in interpreting the symptoms of an acute concussion.

A Cross-Sectional Investigation of Trait Mindfulness, Concussion Symptom Severity, and Quality of Life in Adults with Persisting Symptoms Postconcussion.

Individual differences in mindfulness may impact quality of life after concussion. In a cross-sectional analysis, the moderating effect of mindfulness was tested on the association between symptom severity and quality of life in adults with persisting postconcussion symptoms (N = 85). Mindfulness and symptom severity were independently associated with quality of life; however, mindfulness did not moderate this association. "Nonreactivity" was independently associated with quality of life; however, it was not a significant moderator. Taking a nonreactive stance, or allowing experiences to come and go without effort to change them, may be relevant to quality-of-life outcomes after concussion.

Perceived Stress, Mindfulness, and Clinical Concussion Outcomes in Adults with a Concussion History

ABSTRACT Introduction Higher perceived stress negatively impacts concussion recovery, but there are limited data examining connections between perceived stress and concussion. Additionally, higher mindfulness is associated with lower perceived stress, but there is limited research on how mindfulness impacts concussion outcomes. Therefore, this study aimed to estimate the associations among perceived stress, mindfulness, and clinical concussion outcomes. Methods This was a cross-sectional, observational study in 80 young adults with a concussion history. Participants completed a single study visit measuring the following: 1) demographics, concussion history, and current mindfulness practice; 2) perceived stress (Perceived Stress Scale); 3) mindfulness (Five Facet Mindfulness Questionnaire); and 4) clinical concussion outcomes/symptoms (Rivermead Post-Concussion Symptoms Questionnaire), balance performance (Balance Error Scoring System (BESS) and center of mass), autonomic nervous system function (heart rate variability), vestibular/ocular function (vestibular ocular motor screening), and exertion tolerance (step test). Separate multivariable linear regression models were used to determine the associations among 1) perceived stress and clinical concussion outcomes and 2) mindfulness and clinical concussion outcomes. Next, a perceived stress and mindfulness interaction term was included to test the potential moderation effect of mindfulness on clinical concussion outcomes. Results Higher perceived stress was significantly associated with higher concussion symptom severity (P &lt; 0.001) and higher number of concussion symptoms reported as worse than before injury (P &lt; 0.001). Higher mindfulness was associated with lower concussion symptom severity (P &lt; 0.001), and fewer concussion symptoms reported as worse than before injury (P = 0.002). There were no clinically significant models where the interaction effect was also significant, but the BESS parameter estimate did show statistical significance in the interaction model. Conclusions Our results provide a novel understanding of the association among perceived stress, mindfulness, and clinical concussion outcomes. These data are necessary to inform mechanistic concussion rehabilitation interventions.

The role of concussion history and biological sex on baseline concussion clinical profile symptoms in adolescent rugby players

BackgroundAccurate concussion monitoring requires access to preinjury baseline data. This is particularly important in adolescent athletes who have a high risk of concussion and are prone to prolonged recovery. As Rugby Union is governed by similar laws for men and women, it is also an ideal population to rigorously examine the impact of biological sex on concussion symptoms.AimsTo evaluate self-reported concussion symptoms at baseline in adolescent rugby union players, and examine if subtype-specific symptoms are affected by concussion history and biological sex.MethodsAdolescent rugby union players aged 16–18 years were recruited during the 2022–2023 playing season. Participants completed a series of questionnaires covering post-concussion symptoms, concussion clinical profiles, anxiety, depression and fear avoidance behaviours. Independent variables of interest in analysis were biological sex and concussion history.Results149 participants (75% male) were included. 42% (63/149) reported at least one previous concussion (average time since concussion: 18.7 months, range 1–72). Adolescents with a concussion history reported significantly higher scores than those with no history, across two clinical profiles (ocular and sleep), concussion symptom severity, and depression, all based on medium effect sizes (SMD 0.3–0.5). Females had significantly higher scores across cognitive/fatigue, ocular and sleep clinical profiles, concussion symptoms, anxiety and depression, each with large effect sizes (SMD > 0.5).ConclusionsConcussion history and sex are associated with higher baseline scores on specific concussion clinical profile, concussion symptom severity, and anxiety symptoms. These findings highlight the importance of considering baseline differences when interpreting post-injury clinical profile symptoms in adolescent rugby players. (Trial registration: ACTRN12622000931774).

Relationship between severity of concussion’s symptoms and functional performance in children

ABSTRACT Introduction Concussion is a common brain injury that has significant effects on multiple functional domains in children. However, limited research exists on the relationship between concussion severity and functional performance in this population. This study aimed to examine the relationship between the severity of concussion symptoms and children’s balance and functional performance. Methods This cross-sectional study recruited 23 children (9 males and 14 females; mean age 13.9 ± 2.2 years) with clinically diagnosed concussions from a tertiary balance center in 2016. Participants underwent clinical and functional evaluations by specialized physical therapists. Symptom severity was assessed using the Post-Concussion Symptom Scale (PCSS), while functional performance was measured using the Functional Gait Assessment (FGA). Results There was a trend suggesting a negative correlation between symptom severity (PCSS) and functional performance (FGA), indicating potentially better performance in individuals with milder symptoms. However, this trend was not significant (rs (21) = –.072, p = 0.744). Furthermore, no significant correlation was found between FGA scores and the severity of individual symptoms. Conclusion The findings suggest that concussion symptom severity may not be directly related to functional performance in children. Therefore, it is crucial to incorporate functional performance measures alongside symptom assessment for comprehensive concussion management.

Validation of a Brief Cognitive Assessment for Concussion Delivered on a Mobile Device

Previous research found the Conners Continuous Performance Test (3rd ed; CCPT3) to predict concussion outcomes, but delivery was on a desktop device which can undermine broad use. We examine whether a shortened, mobile CCPT3 predicts concussion symptom endorsement and severity, and evaluate whether the predictive validity changes after controlling for ADHD. From July 2021 to January 2022, 143 participants aged 11 to 23 (approximately 30% female), including 63 consecutively assessed individuals suspected of having a concussion, and 80 randomly selected healthy controls, completed the mobile CCPT3 and the 31-item CDC concussion symptom checklist with severity ratings. Regression analyses indicate the mobile CCPT3 accounts for 19% variance (p < 0.01, d = 0.97) in symptom severity and 17.2% variance (p < 0.01, d = 0.91) in symptom endorsement. Findings persist after controlling for the experience of ADHD. Moreover, CCPT3 scores can differentiate among those suspected of having a concussion, predicting 27.6% variance in total symptom severity (p = 0.02, d = 1.24). Thus, a brief, objective mobile cognitive assessment yields large effect sizes when predicting concussion symptoms, and findings are comparable to previous research. Because the mobile assessment can be administered almost immediately post-injury and in between clinical visits, it can further inform post-injury medical care, rehabilitation, and return-to-play decisions.

Concussion risk and symptomology severity in adolescents are associated with pre-season drowsiness and emotional complaints.

Concussions are an ever present risk for many sports. Underlying emotional disturbances and drowsiness are associated with worse post-concussion symptom scores. Yet, not study has examined associations of both emotional disturbances and drowsiness on concussion severity and symptomology. Examine the associations between baseline sleepiness, emotional complaints, and concussion risk and symptom severity in adolescent athletes. A cohort of 626 adolescent athletes underwent baseline/pre-season concussion screening. Those who experienced a physician diagnosed concussion underwent follow up concussion symptomology assessment. Over 90% of players were seen within two weeks of the concussion incident. Linear regression examined for associations between concussion symptom scores and baseline drowsiness and baseline emotional symptoms. Logistic regression examined for association between each symptom and baseline drowsiness and baseline emotional symptoms. Of the 626 athletes that underwent baseline testing, 292 experienced a concussion. Of those 292 athletes, 174 (59.6%) reported baseline drowsiness and 183 (62.7%) baseline emotional symptoms. Baseline drowsiness and emotional complaints were associated with a 2.6 (95% confidence interval = 1.9 to 3.6) and 2.8 (95% confidence interval = 2.0 to 3.9) times greater odds of sustaining a concussion respectively. Increased symptomology after concussion was associated with both baseline drowsiness (unstandardised b = 4.6, p < 0.01) and baseline emotional complaints (unstandardised b = 6.0, p < 0.01). Preseason drowsiness and emotional complaints in adolescent athletes are associated with higher risk of adverse clinical outcomes following concussion. Therefore, clinicians and coaches should be aware, and properly screen, for sleep and emotional problems as part of pre-season/baseline health screening.

Postconcussion Moderate to Vigorous Physical Activity Predicts Anxiety Severity among Adolescent Athletes.

This study aimed to examine how moderate-to-vigorous physical activity (MVPA) during concussion recovery influences self-reported anxiety symptoms at follow-up assessment. We hypothesized that more MVPA after concussion would be associated with lower anxiety rating at follow-up. We performed a prospective study of participants aged 13-18 yr initially assessed within 14 d of diagnosed concussion. Participants rated concussion symptoms using the Post-Concussion Symptom Inventory and were provided a wrist-worn actigraphy device to track activity for 1 wk after assessment. At follow-up assessment, participants rated anxiety symptoms using the four-question Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety subscale. Each question ranged from 1 (never) to 5 (almost always), with an overall score range of 4-20. For univariable analysis, we calculated correlation coefficients between MVPA and PROMIS anxiety subscale scores. We then created a multiple linear regression model with follow-up PROMIS anxiety subscale score as the outcome and MVPA, sex, initial symptom severity, and preconcussion anxiety as predictors. We enrolled and initially tested 55 participants, and 48 were included in the final analysis (age, 14.6±2.7 yr; 56% female; initial assessment, 7.3± 3.1 d; follow-up assessment, 42.0±29.7 d). We observed an inverse and low correlation between MVPA and follow-up PROMIS anxiety subscale T-scores ( r = -0.30, P = 0.04). Multivariable regression results indicated that MVPA ( β = -5.30; 95% confidence interval (CI), -10.58 to -0.01), initial Post-Concussion Symptom Inventory score ( β = 0.11; 95% CI, 0.03 to 0.19), and preconcussion anxiety ( β = 5.56; 95% CI, 0.12 to 11.0), but not sex ( β = -2.60; 95% CI, -7.14, to 1.94), were associated with follow-up PROMIS anxiety subscale T-scores. After adjusting for covariates, more MVPA early after concussion predicted lower PROMIS anxiety subscale scores at follow-up. Although initial concussion symptom severity and preconcussion anxiety were also associated with follow-up PROMIS anxiety subscale score, MVPA represents a modifiable factor that may contribute to lower anxiety symptoms.

Exercising More Than 150 min/wk After Concussion Is Associated With Sleep Quality Improvements.

To examine whether a high volume of aerobic exercise after concussion (>150 min/wk) is associated with improved sleep quality over a 1-month period. We hypothesized that more than 150 min/wk of exercise would be associated with improved sleep quality across concussion recovery. Prospective cohort observational study. Sports medicine clinic. Adolescents initially tested 8.4 ± 3.5 (range, 2-18) days postconcussion who returned for a follow-up assessment 34.3 ± 7.7 (range: 20-49) days postconcussion. Participants completed the Pittsburgh Sleep Quality Index and the Post-Concussion Symptom Inventory. No specific exercise or sleep recommendations were given beyond what their treating physician provided. Between study visits, participants recorded exercise performed via wrist-worn actigraphy. We calculated average exercise minutes per week and grouped participants as those who exercised more than 150 min/wk versus those who exercised 150 min/wk or less. Thirty-six adolescents participated. Fifteen (42%) recorded more than 150 min/wk of aerobic exercise (age = 14.0 ± 1.7 years; 47% female; mean = 5.6 ± 1.2 d/wk of exercise; mean = 49.2 ± 17.5 min/session), and 21 recorded 150 min/wk or less of aerobic exercise (age = 15.0 ± 1.9 years; 76% female; mean = 2.7 ± 1.6 d/wk of exercise; mean = 30.2 ± 7.8 min/session). There were no significant group differences in the proportion of those who self-reported beginning physical activity prior to enrollment (47% vs 33%; P = .42) or for initial sleep quality rating (8.0 ± 3.7 vs 8.6 ± 4.1; P = .67) or initial concussion symptom severity rating (34.9 ± 28.0 vs 42.6 ± 25.9; P = .40). The group that exercised more than 150 min/wk between visits demonstrated significantly greater median PSQI rating improvements than those who exercised 150 min/wk or less, with a large effect size noted (median change [interquartile range] = 5 [3, 7] vs 1 [0, 4]; P = .008; Cohen d = 0.96). Current recommendations suggest that subsymptom aerobic exercise can be beneficial after concussion. Our findings indicate that an exercise volume of more than 150 min/wk led to greater sleep quality improvements than those who exercised below this level.

A-21 Do Guardian Caps Reduce Concussion Frequency, Symptom Severity, and Time-Loss After Concussion In Football Athletes?

Abstract Purpose The Guardian Cap (GC) was designed to mitigate biomechanical forces to football helmets. This pilot study was designed to examine if the use of GCs reduced concussion frequency, total symptom severity (TST), and days-until-symptom-resolution (DUSR) following a SC in collegiate football athletes. We hypothesized the GCs would not decrease SC frequency, TST, or DUSR. Methods Participants (N=14) in our cross-sectional study were Division I collegiate football athletes who were diagnosed with a SC (20.0±1.32 years old) who did (GC; n=3) or did not (NoGC; n=11) wear the GC. Only SCs that occurred to athletes required to wear the GC during practice were included in our analyses. As spring practice was cancelled during 2020 due to COVID-19, only fall practices were included in our analyses. The head coach remained consistent during the NoGC and GC study periods. Descriptive statistics were used to examine concussion frequency. Mann-Whitney U tests were used to compare TST and DUSR between groups. Also, [interquartile range] could not be calculated for the GC group due to the low number of SCs. Results On median, the number of SCs decreased from 4 to 1.5 per season from the NoGC to the GC period. On median DUSR decreased from 13.5[11] to 5[n/a] for the NoGC and GC groups, respectively (U=9.50,z=-.93,p=.35). TST also decreased from 16[27] to 6[n/a] in the NoGC and GC groups, respectively (U=5.0,z=-1.79,p=.07). Conclusions GCs may potentially reduce concussion frequency, TST, and DUSR, however, future research with a larger sample size is needed to confirm and extend our findings.

Contact or Collision Sport History, Repetitive Neurotrauma, and Patient-Reported Outcomes in Early to Midadulthood.

Data on the early to midlife effects of repetitive neurotrauma on patient-reported outcomes have been delimited to homogeneous samples of male athletes without comparison groups or accounting for modifying factors such as physical activity. To determine the effect of contact or collision sport participation and repetitive neurotrauma on patient-reported outcomes among early to middle-aged adults. Cross-sectional study. Research laboratory. A total of 113 adults (53 [46.9%] men, 60 [53.1%] women; age = 34.88 ± 11.80 years) in 4 groups: (1) physically inactive individuals with no repetitive head impact (RHI) exposure (NON); (2) noncontact sport athletes and nonathletes with no RHI exposure who were currently physically active (NCA); (3) former high-risk sport athletes with an RHI history who were physically active (HRS); and (4) former rugby players with prolonged RHI exposure who remained physically active. The 12-Item Short-Form Health Survey (SF-12), Apathy Evaluation Scale-self-rated version (AES-S), Satisfaction With Life Scale (SWLS), and Sport Concussion Assessment Tool-5th Edition (SCAT5) Symptom and Symptom Severity Checklist. The NON group had worse self-rated physical function than the NCA group as assessed by the SF-12 physical component summary (P = .03) and worse self-rated apathy (AES-S) and satisfaction with life (SWLS) than the NCA (P = .03 for both) and HRS groups (P = .03 and P = .040, respectively). We observed no group differences for self-rated mental health (SF-12 mental component summary; P = .26) or symptoms (SCAT5; P = .42). Career duration was not associated with any patient-reported outcomes. A history of contact or collision sport participation and career duration did not negatively affect patient-reported outcomes in physically active, early to middle-aged adults. However, physical inactivity status was negatively associated with patient-reported outcomes in these individuals in the absence of an RHI history.

Baseline concussion assessment performance by sex in military service academy rugby players: findings from the CARE Consortium

BackgroundNormative student-athlete concussion assessment data may not be appropriate for service academy members (SAMs), particularly rugby players, because of the uniqueness of their academic/military training environment. Having accurate baseline data...

Test-Retest Reliability and Efficacy of Individual Symptoms in Concussion Management.

(1) To determine test-retest reliability of individual Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom scores and symptom severity scores, (2) to examine the specificity/sensitivity of individual SCAT-3 symptom severity scores acutely (24-48 hours) postconcussion, and (3) to develop a model of symptoms best able to differentiate concussed from nonconcussed student athletes and cadets. Prospective, longitudinal, and cross-sectional. Twenty-six civilian schools and 3 US service academies. Collegiate student athletes (n = 5519) and cadets (n = 5359) from the National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education Consortium, including 290 student athletes and 205 cadets, assessed 24 to 48 hours postconcussion. Concussed and nonconcussed student athlete and cadet groups. Sport Concussion Assessment Tool-Third Edition individual symptom severity scores, total symptom scores, and symptom severity scores. Results indicated poor test-retest reliability across all symptom scores (intraclass correlation coefficient = 0.029-0.331), but several individual symptoms had excellent predictive capability in discriminating concussed from nonconcussed participants (eg, headache, pressure in the head, and don't feel right had area under the curve >0.8, sensitivity >70%, and specificity >85%) regardless of baseline testing. These symptoms were consistent with Chi-square Automatic Interaction Detector classification trees with the highest mean probability. Findings support the excellent diagnostic accuracy of honest symptom reporting, notwithstanding the known limitations in symptom underreporting, and suggest that there may be added value in examining individual symptoms rather than total symptom scores and symptom severity scores alone. Finally, findings suggest that baseline testing is not necessary for interpreting postconcussion symptom scores.

Greater Acute Concussion Symptoms Are Associated With Longer Recovery Times in Adolescents.

We examined the association between the severity of acute concussion symptoms and time to return to school and to sports in adolescent student athletes. We hypothesized that there would be an association between the severity of acute symptoms experienced in the first 72 hours and functional recovery such that adolescents with the lowest burden of acute symptoms would have the fastest return to school and sports and those with the highest burden of symptoms would have the slowest return to school and sports. This injury surveillance cohort included 375 adolescent student athletes aged 14-19 years who sustained a sport-related concussion between 2014 and 2020. Athletic trainers documented time to return to school and to sports. A greater proportion of adolescents with the highest acute symptoms remained out of school at 3 (odds ratio [OR] = 2.5, 95% confidence interval [CI] 1.5-4.4), 5 (OR = 2.4, 95% CI 1.4-4.0), 7 (OR = 2.6, 95% CI 1.5-4.3), and 10 days (OR = 2.3, 95% CI 1.3-3.9) compared to those with the lowest acute symptoms. Similarly, a greater proportion of athletes with the highest acute symptoms remained out of sports at 7 (OR = 3.5, 95% CI 1.5-8.1), 10 (OR = 3.1, 95% CI 1.8-5.6), 14 (OR = 1.8, 95% CI 1.1-3.0), and 21 days (OR = 1.9, 95% CI 1.0-3.6) compared to those with the lowest acute symptoms. This study underscores the adverse effect of high acute symptom burden following concussion on return to school and to sports among adolescent student athletes. Conversely, student athletes with a low burden of acute symptoms have a faster return to school and to sports.

Persisting symptoms after concussion: Time for a paradigm shift.

Persisting symptoms after concussion: Time for a paradigm shift.

Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion.

Background:Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them.Purpose:To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls).Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5.Results:The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively).Conclusion:During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.

The Association Of Pre-season Sleep And Emotional Complaints With Concussion Risk And Symptoms In Adolescents

PURPOSE:This study investigated the associations of baseline sleep and emotional complaints on concussion severity and symptomology in adolescents (10-18 years old). METHODS: Pre-season/baseline concussion assessments were prospectively collected in 626 adolescent participants (age = 15.5 ± 1.7 years). Part of this baseline assessment examined symptoms, including those related to sleep disturbances and emotional complaints. Participants who experienced physician-diagnosed concussion during the season underwent follow up concussions symptom assessments. Linear regressions determined associations between overall concussion symptom scores and 1) baseline drowsiness, 2) baseline emotional symptoms and 3) the combination of both baseline drowsiness and emotional symptoms. Logistic regressions determined associations between all concussion symptoms and baseline drowsiness (Model 1), baseline emotional symptoms (Model 2) and the combination of both baseline drowsiness and emotional symptoms (Model 3). Both the linear and logistic regressions adjusted for age, time from injury, number of previous concussions, loss of memory during most recent concussion and loss of consciousness during most recent concussion. RESULTS: From 292 (15.7 ± 1.7 years) concussions, 174 reported baseline drowsiness and 183 baseline emotional symptoms. Increased concussion symptom scores were associated with both baseline drowsiness and emotional symptoms (unstandardised b [B] > 4.6, p < 0.01, along with a 2.6 (95% CI = 1.9 to 3.6) and 2.8 (95% CI = 2.0 to 3.9) times greater odds of sustaining a concussion, respectively. Sleep and emotional complaints in adolescent athletes are associated with higher risk of adverse clinical outcomes from concussion. CONCLUSIONS: This study indicated sleep problems and emotional disturbances during pre-season can precipitate and exacerbate concussion. As both sleep and emotions are controlled by the limbic system, dysfunction of the limbic system may play an important role in concussion symptom severity. However future research is needed to explore this premise.