Post-Concussion Symptom Scale Research Articles

Performance on the Concussion Balance Test Is Indicative of Time to Recovery in Athletes Following Sports-Related Concussion: An Exploratory Analysis.

Sports-related concussions (SRCs) are commonly occurring injuries among athletic and recreationally active populations. SRCs can result in vestibular dysfunction that should resolve before returning to activity. It has been suggested that vestibular impairment is a factor that may influence recovery time. The objective of this study was to evaluate the effect of vestibular function on recovery following SRC. Retrospective chart review. Multidisciplinary Concussion Clinic. A total of 32 patient charts (21 males, 15.34 [1.47]y, 171.29 [8.44]cm, 68.37 [15.47]kg) from patients diagnosed with SRC presenting to a concussion clinic between August of 2016 and July 2017 with clinician-identified vestibular involvement were included. Scores on the Post-Concussion Symptom Scale, Dynamic Visual Acuity Test, Gaze Stabilization Test, Concussion Balance Test (COBALT), and other clinical data were used for analysis. Descriptive statistics were calculated for all variables. Pearson correlations were used to identify variables related to time to recovery. Variables were entered into a forward linear regression model. Moderate to good relationships were identified between days to recovery and Dynamic Visual Acuity Test lines lost in the leftward direction (1.17 [0.52]; r = .39, P = .04), COBALT-condition 8 sway velocity (1.20 [0.18]; r = .44, P = .01), and days to successful completion of the COBALT (14.72 [8.35]; r = .63, P < .001). Patients' predicted time to recover was equal to 14.61 (0.86) (days to successful COBALT). The model was significant (P < .001, R2 = .30). The single predictor of time to recover was the number of days to successful completion of the COBALT. Thus, the ability to complete the task may be more informative than the performance on the task in predicting recovery time.

The Co-Occurrence of Vestibular/Ocular Motor Provocation and State Anxiety in Adolescents and Young Adults with Concussion.

Vestibular/ocular motor provocation and state anxiety are both independently linked to poor recovery outcomes following concussion. However, the relationship between these two clinical presentations and their co-occurring effects on concussion recovery outcomes is understudied. The purpose was to examine the co-occurring effects of vestibular/ocular motor provocation and state anxiety following concussion. There were 532 participants (15-25 years) with concussions who completed the vestibular/ocular motor screening (VOMS), State-Trait Anxiety Inventory, and the Post-Concussion Symptom Scale within 30 days of injury. Participants were classified into provocation (PROV) and no provocation (NO PROV) groups based on exceeding/not exceeding VOMS cutoffs. An analysis of covariance was used to examine between-group comparisons on state anxiety scores; and logistic regressions, with adjusted odds ratios (Adj OR), were used to evaluate predictors of clinical levels of state anxiety and protracted recovery. A total of 418 participants (78.6%; age = 17.2 ± 2.6; 65% female) exceeding VOMS cutoffs were in the PROV, and 114 (21.4%; age = 16.6 ± 2.2; 53% female) participants were in the NO PROV group. The PROV group (mean [M] = 39.50, standard deviation [SD] = 12.05) exhibited significantly higher state anxiety scores than the NO PROV group (M = 32.45, SD = 10.43) (F[1, 532] = 15.36, p < 0.001, η2= 0.03). Vestibular/ocular motor provocation (Adj OR =3.35, p < 0.001, 95% confidence interval [CI]: 1.42-3.88) was the most robust predictor of clinical state anxiety following concussion (χ2 [4, 532] = 86.78, p < 0.001). Participants exhibiting vestibular/ocular motor provocation with clinical levels of state anxiety were at 2.47 times (p < 0.001, 95% CI: 1.53-3.99) greater odds of experiencing a protracted concussion recovery than participants with vestibular/ocular motor provocation without clinical state anxiety. Vestibular/ocular motor provocation is associated with increased state anxiety following concussion, and the addition of clinical state anxiety to vestibular/ocular motor provocation increases the odds for protracted recovery. Clinicians should assess vestibular/ocular motor function and anxiety following concussion.

Effect of Sleep Duration and Concussion History on Neurocognitive Testing Symptoms for Post-injury States.

Evaluate the influence of sleep duration and concussion history on postconcussion symptoms in adolescent athletes. Observational retrospective study using the Immediate Post-Concussion Assessment and Cognitive Testing and Post-Concussion Symptom Scale (PCSS). Multivariable linear regression assessed sleep hours against 22 PCSS symptoms, controlling for demographic and health variables. Urban concussion centers in Colorado and Florida, 2009 to 2019. 11 564 student-athletes aged 12 to 22, categorized by concussion history. Analysis of sleep duration and concussion history in relation to neurocognitive and psychiatric symptom severity. Primary outcomes included neurocognitive, psychiatric, and total symptom scores. Secondary outcomes were specific PCSS symptoms. Among 5349 student-athletes, 2671 (49.9%) had no prior concussions and 2678 (50.1%) had 1 or more. For those without prior concussions, sleep was negatively associated with age (β = -0.18, 95% confidence interval [CI], -0.22 to -0.13, P < 0.0001), vomiting (β = -0.22, 95% CI, -0.38 to -0.05, P = 0.012), and difficulty concentrating (β = -0.11, 95% CI, -0.19 to -0.35, P = 0.005). In athletes with a history of concussion, less sleep correlated with decreased age (β = -0.11, 95% CI, -0.14 to -0.07, P < 0.0001), headache (β = -0.065, 95% CI, -0.12 to -0.01, P = 0.031), irritability (β = -0.08, 95% CI, -0.15 to -0.01, P = 0.021), and difficulty concentrating (β = -0.08, 95% CI, -0.15 to -0.01, P = 0.031) but increased sensitivity to light (β = 0.10, 95% CI, 0.001-0.137, P = 0.048), numbness/tingling (β = 0.15, 95% CI, 0.04-0.26, P = 0.008), and feeling slowed down (β = 0.13, 95% CI, 0.05-0.21, P = 0.001). Sleep duration and concussion history are associated with variations in postconcussion symptom severity among adolescent athletes. This data underscore the need for individualized management strategies based on sleep patterns and concussion history.

Symptom Exacerbation and Adverse Events During a Randomized Trial of Early-Stage Rehabilitation After Sport-Related Concussion: Safety Outcomes From the Active Rehab Study.

Authors of few studies have used randomized controlled trials (RCTs) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels. Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions. Cluster RCT (NCT02988596). Sports medicine clinic and field settings. The RCT enrolled 251 concussed athletes (median age = 20 years; female, n = 48) across 28 sites from New Zealand professional rugby (n = 31), Canadian professional football (n = 52), US/Canadian colleges (n = 128) and US high schools (n = 40). Two medically supervised interventions: (1) enhanced graded exertion (EGE): international return-to-sport strategy and sport-specific activities only (EGE only, n = 119); and (2) multidimensional rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR + EGE, n = 132). Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with the Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n = 1437) were the primary analysis unit. Frequencies, proportions, medians, and interquartile ranges were calculated for outcomes by treatment group. The 251 postinjury participants completed 1437 (MDR + EGE = 819, EGE only = 618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR + EGE and EGE-only arms, respectively. Intrasession symptom exacerbations were equivalently low in MDR + EGE and EGE-only arms (MDR + EGE: 16.7%, 95% CI = 14.1%, 19.1%; EGE only: 15.7%, 95% CI = 12.8%, 18.6%). In total, 9/819 MDR + EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a presession to postsession symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported. Participants in MDR + EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.

Cervical spine sensorimotor deficits persist in people post-concussion despite minimal symptoms

Background The mechanisms of a concussion place stress on the cervical spine like that of a whiplash event, which can result in cervical spine dysfunction. This study aimed to determine if underlying cervical spine mobility and sensorimotor function deficits occur in individuals who are post-concussion with near resolution of symptoms. Methods Twenty-five participants with a self-reported concussive event within a year (PC group: post-concussion 157 + 120 d, 9 men, age: 25 ± 8 yr) and 26 comparable peers (Peer group, 9 men, age: 25 ± 7 yr) were tested. The Post-Concussion Symptom Scale (PCSS) quantified residual concussion symptoms. Participants completed cervical joint position error (JPE) and cervical spine joint mobility tests blinded from each other. Group mean differences were analyzed using t-tests. Results The PC group had minimal symptoms (PCSS = 6.8 ± 6.5) but substantial differences in JPE tests compared to the Peer group (PC = 7.4 ± 1.8 cm; PG = 5.6 ± 1.1 cm; p < .001). Those PC participants with pain during joint testing (n = 15) had worse JPE (Painful = 8.1 ± 1.8 cm, No-pain = 6.3 ± 1.6 cm; p = .02) and less averaged lower cervical spine joint mobility compared to PC participants without pain (Painful = 0.66 ± 0.22, No-pain = 0.87 ± 0.19; p = .02, Normal motion = 1.0). Conclusion Following a concussion, it is a reasonable recommendation to screen the cervical spine to identify impairments in joint mobility and JPE that contribute to neck dysfunction.

The Role of Body Mass Index on Physical Activity, Symptoms, and Related Outcomes Following Pediatric Concussion

To determine the step count and self-reported activity levels for obese and nonobese pediatric patients following concussion and predict self-reported symptoms, quality of life, and psychological health over time. Participants completed the Post-Concussion Symptom Scale (PCSS), Pediatric Quality of Life (PedsQL), and Behavioral Symptom Inventory-18 (BSI-18) at an initial visit (<72hours), 3-5days postinjury, 10-18days postinjury, and 1 and 2months postinjury. Physical activity data (eg, step count) were collected via a commercial actigraph. Participants were categorized into obese and nonobese body mass index (BMI) groups based on age- and sex-adjusted growth standards. Mann-Whitney U tests compared groups while nonparametric series regression models examined the effect of obese BMI and average daily step count on PCSS, PedsQL, and BSI-18 outcomes at 1 and 2 months postinjury. One hundred ninety-four participants were included: 153 (78.9%; M=14.6±2.4years; 50% female) in the nonobese group and 41 (21.1%; M=14.2±2.0years; 44% female) in the obese group. The obese group had a 22.8% lower average daily step count in the week postinjury (P=.02). At 2 months, there was a significant association between obese BMI and worse PCSS total score (P=.042), PedsQL (P=.017), and BSI-18 anxiety (P=.046). Average daily step count in the first week postinjury was associated with a higher PCSS total score at 2months (P=.031). Pediatric patients following concussion with an obese BMI had a lower daily average step count in the week after injury and exhibited worse concussion symptoms, quality of life, and anxiety at 2months compared with those with a nonobese BMI. Active Injury Management (AIM) after Pediatric Concussion: NCT03869970.

Factors that Influence Recovery From Concussion in Young Children and Preadolescents.

To examine differences in the presentation and management of concussion in younger children (aged 4-8 years) versus preadolescents (9-12 years) and identify factors that influence recovery time. Retrospective analysis of prospectively collected data. Pediatric sports medicine and orthopedics clinic. Three hundred seventy-five patients aged 4 to 12 years diagnosed with concussion between 2020 and 2022. Age, gender, race/ethnicity, mechanism of injury (sport vs nonsport related), neurodevelopmental or psychiatric diagnosis, concussion history, Post-Concussion Symptom Scale (PCSS) score, and Vestibular Ocular Motor Screening (VOMS) overall change scores. Days since injury (DSI) to initial visit, total number of visits, recovery time (days). Groups significantly differed in DSI (P = 0.01) and overall VOMS change score (P = 0.03). No differences were observed between groups on total number of visits or recovery time. Patients with fewer DSI [odds ratio (OR) = 1.15], less change in overall VOMS score (OR = 1.02), lower PCSS scores (OR = 1.02), and who were injured in sport were less likely to experience a protracted recovery. Younger children with concussion may be appropriately treated with a similar approach to preadolescent patients despite greater DSI and differences in VOMS change scores, without sacrificing overall recovery time. Consistent with research in older cohorts, protracted recovery was seen in nonsport patients, and patients seen sooner at a specialty concussion clinic were less likely to experience a protracted recovery, endorsed lower PCSS scores, and had lower overall VOMS change scores. Further research is needed to solidify a child-specific paradigm to concussion management.

7280 Pituitary Dysfunction Following Mild Traumatic Brain Injury in Female Athletes: Neuropsychological and Psychological Functioning

Abstract Disclosure: L.Ó. Eggertsdóttir Claessen: None. M.K. Jónsdóttir: None. H. Kristjánsdóttir: None. S.H. Lund: None. I. Unnsteinsdóttir Kristensen: None. H.Á. Sigurjónsdóttir: None. Background: Pituitary dysfunction (PD), as well as neuropsychological and psychological symptoms, have been reported following mild traumatic brain injury (mTBI). These symptoms may be due to the brain injury itself or PD as hypopituitarism (HP) can have neuropsychological and psychological effects. To the best of our knowledge, this study is the first to report neuropsychological and psychological outcomes in female athletes with PD following sport-related mTBI. Subjects: Female athletes aged 18 to 45 years currently active in or retired from soccer, team handball, basketball, ice hockey, and martial arts who answered an online questionnaire regarding mTBI history and mental health were included (n = 508). Of the 308 women who reported one or more mTBI, 166 (53.8%) accepted to participate in a further interview and neuropsychological tests. All 166 women were subsequently invited to participate in a medical interview. Of those 151 accepted (90.9%) and 131 (86.7%) of them participated in pituitary hormone screening blood tests (SBT). Methods: The online questionnaire included a post-concussion symptom scale, and mental health scales evaluating symptoms of anxiety, depression, stress, and quality of life. Sleep disturbances were evaluated, and neuropsychological tests were performed in the psychological interview. The Sustained Attention to Response Task (SART). Executive functioning, visual search, motor and processing speed, divided attention, working memory, and intellectual abilities were also measured. The SBT were taken at 8 a.m. and included S-IGF1 (age dependant reference range), S-cortisol (values &amp;lt; 350 nmol/L were considered abnormal), S-prolactin (reference range 4.79 - 23.3 μg/L), S-TSH (reference range 0.270 - 4.20 mIU/L), S-fT4 (reference range 12 - 22 pmol/L), S-FSH, S-oestrogen, and S-progesterone measurements. If SBT were repeatedly O-RV, detailed endocrinological tests were performed for each axis as indicated. Results: Following a detailed endocrinological evaluation, 16 women were diagnosed with PD (HP n = 6, hyperprolactinemia n = 10) following mTBI. Women with PD had a significantly higher mean SART error score than women with normal pituitary function (PF) (16.7 and 12.8 respectively; p = 0.04). No other significant differences in neuropsychological outcome were found between the two groups. Moreover, there was not a significant difference with regards to mTBI symptoms, anxiety, depression, stress, QOL or insomnia between women with PD and those with normal PF. Conclusions: Sustained attention or inhibitory performance may be affected in women with PD following mTBI as they had a higher mean SART error score than women with normal PF. No other significant difference in neuropsychological or psychological outcome was demonstrated. Presentation: 6/3/2024

Comparison of the GAD-7 and ImPACT symptom cluster scores in measuring anxiety among college athletes

Assessing mental health needs among college athletes is important given the frequency of symptoms of depression and anxiety and associated complications that may arise after a sports-related concussion. The purpose of this study was to explore the utility of the General Anxiety Disorder-7 (GAD-7) as an independent measure of anxiety symptoms among Division II collegiate athletes (n = 568) during baseline concussion assessments, which also included the post-concussion symptom scale (PCSS) and a measure of depression, the Patient Health Questionnaire-9 (PHQ-9). While only 31 athletes (5.5%) fell above the established GAD-7 cutoff score of 5 or more, a sizable proportion of them (13 or 41.9%) endorsed 0 items on the PCSS affective symptom cluster. Additionally, ∼2% of athletes reported elevated symptoms of anxiety but not depression. These findings support the incorporation of a brief stand-alone anxiety screening tool during concussion baseline evaluations to ensure better detection of student athletes with elevated anxiety symptoms who might otherwise be overlooked, so they may be referred for further diagnostic assessment.

B - 48 Gender-Based Network Comparisons of the Post-Concussion Symptom Scale at Acute Post-Concussion

Abstract Objective Prior literature suggests there may be gender-based differences in Post-Concussion Symptom Scale (PCSS) scores, with girls reporting more symptoms than boys at pre- and post-concussion. PCSS network analysis comparisons on gender have been conducted at pre-concussion but not post-concussion, which can determine whether gender-based differences in symptom relationships exist post-concussion. We conducted network comparisons between boys and girls from a sample of high school athletes at acute post-concussion to analyze differences in symptom relationships. Method Separate network analyses were conducted on acute post-concussion PCSS scores (within 72 hours post-suspected concussion) for boys (n = 2032) and girls (n = 1246), with nodes representing PCSS items and edges representing partial correlations between them. Expected influence was calculated to determine node importance in each network. Network Comparison Tests were used to compare network structure, global connectivity, and expected influence. Results Both networks’ expected influences and edge weights were stable and interpretable. There were no significant differences in network structure, connectivity, and expected influence between the groups. Networks consisted of positive and negative edges; strongest edges connected symptoms within similar domains (e.g., light and noise sensitivity). Conclusions Current results suggest that prior reports of gender-based differences in PCSS scores following concussion do not appear to be accounted for by differences in how PCSS items interact and influence each other. Differences may reflect actual differences in type and severity of post-concussion symptoms experienced by boys and girls or reflect differences in symptom reporting based on cultural influences. Future research could examine cultural or societal factors that influence gender-based differences in symptom reporting.

B - 57 Examining Symptom Patterns in Anomalous Health Incidents: a Spectral Co-Clustering Analysis Using the Post-Concussion Symptom Scale

Abstract Objective The ImPACT Post-Concussion Symptom Scale (PCSS) is widely used to document post-concussion symptoms. This study investigated the structural patterns of PCSS using spectral co-clustering on data from U.S. diplomats and their families who served in Cuba and China, who reported experiencing Anomalous Health Incidents (AHIs). Method Clinicians at the University of Pennsylvania evaluated 65 individuals with potential AHI exposure (Median age-group = 35–45 years; 73.84% in Cuba; 49.23% females). PCSS feature scores were discretized into 4-level symptom severity expressions: none, mild, moderate, and severe. The preprocessed data were fit with spectral co-clustering model to extract optimal number of biclusters, by measuring scree plot with principal component analysis and Calinski-Harabasz (CH) score. Final model was also evaluated by CH score and a random label t-test to compare the significance of the clustering results. Results Overall, spectral co-clustering yielded two biclusters with CH score of 20.29 and random label t-test of p &amp;lt; 0.001, suggesting reasonable clustering quality. Biclustering identified two sets of interpretable PCSS symptom characteristics. Cluster centroids X and Y (IDs retracted) were estimated using Manhattan distance, summarizing symptom characteristics of each cluster. More precisely, centroid X represented mild to moderate symptom profiles (e.g., headache, dizziness, drowsiness, and nervousness), while centroidY represented a relative absence of symptoms, except for mild nervousness and emotionality. Conclusion The spectral co-clustering of PCSS reveals patterns of elevated symptoms in one cluster and minimal symptom burden in the other, similar to outcomes observed after mild TBI. These patterns can guide future research directions and ultimately improve patient outcomes in various medical contexts.

Outcome measures used in adolescent sport-related concussion research: a scoping review

ObjectivesTo provide an overview of the outcome measures currently used after sports-related concussion (SRC) in adolescents, categorising by the constructs they assess, follow-up duration and their feasibility of use.DesignScoping review.Data...

Comparative analysis of sport-related concussion: how do 8- to 12-year-old athletes differ from 13- to 17-year-old athletes?

Despite the growing literature on sport-related concussion (SRC) in high school and collegiate athletes, the understanding of how outcomes can vary in child athletes younger than 12 years of age remains limited. Therefore, the authors sought to compare injury characteristics and recovery in 8- to 12-year-old athletes with those of 13- to 17-year-old athletes following SRC. A single-institution retrospective cohort study was undertaken including 8- to 12-year-old and 13- to 17-year-old athletes seen at a regional SRC between November 2017 and January 2022. Demographic information, injury characteristics, Post-Concussion Symptom Scale (PCSS) scores, and recovery (i.e., return to learn [RTL], symptom resolution, and return to play [RTP]) were compared between 8- to 12-year-old and 13- to 17-year-old athletes using the Mann-Whitney U-test and chi-square test. A total of 147 athletes (8- to 12-year-old athletes: n = 49; 13- to 17-year-old athletes: n = 98) were included. The mean ages for the younger and older groups were 10.9 ± 0.9 and 15.7 ± 1.3 years, respectively. Athletes aged 8-12 years and 13-17 years had similar median times to initial healthcare presentation (1 vs 2 days, p = 0.37). Athletes aged 8-12 years were more likely to present to the emergency department (ED) (44.9% vs 25.5%, p = 0.02) and receive head imaging (36.7% vs 19.4%, p = 0.02). Initial PCSS scores were similar between the groups (21.5 vs 22.0, p = 0.99). Athletes aged 8-12 years took longer to RTL (median 6.0 [IQR 4.0-13.0] days vs median 4.0 [IQR 2.0-8.0] days, p = 0.04). However, time to symptom resolution (median 16.0 [IQR 7.0-42.0] days vs median 13.5 [IQR 6.3-22.5] days, p = 0.34) and RTP (median 22.5 [IQR 10.0-54.8] days vs median 15.0 [IQR 10.0-24.0] days, p = 0.17) were not significantly different. Comparing 8- to 12-year-old with 13- to 17-year-old concussed athletes, the authors found that the initial PCSS score did not differ, although the younger group was more likely to present to the ED and receive head imaging. The 8- to 12-year-old athletes took more time to RTL, although no differences were found in time to symptom resolution or RTP.

Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion.

Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation. To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery. Cross-sectional study; Level of evidence, 3. A total of 61 college-aged individuals (21 HC-using women, 21 non-HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores. Significant differences were reported on HIT-6, with the highest headache reporting in the HC group (P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group (P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms (P < .001), symptom severity (P < .001), and vestibular-somatic (P = .024), cognitive-sensory (P = .004), sleep-arousal (P = .001), and affective (P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups (P = .003), with the HC group having greater provocation compared with non-HC users (P = .020). HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.

A - 52 Post-Pandemic Mental Health Symptom Presentations In Canadian Varsity Athletes

Abstract Purpose Mental health (MH) symptoms are often intertwined with concussion symptoms and affect recovery trajectories. Recent studies indicate that the COVID-19 pandemic had a negative impact on athletes’MH, further highlighting the need to understand pre-season baseline MH. This study’s objective was to compare MH symptom frequency and profiles of symptomatology between cohorts of athletes captured pre and post COVID-19. Method Pre-season baseline data from varsity athletes at a Canadian university was collected in 2019, 2022, and 2023 (n = 444) aged 17–25 years (49.8% female). Athletes completed a series of demographic, concussion history, and psychological questionnaires [i.e., Post-Concussion Symptom Scale (PCSS), Generalized Anxiety Disorder Index-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9)]. Results The post-pandemic cohort reported greater numbers of symptoms on the PCSS (M = 4.36, SD = 5.41) compared to the pre-pandemic cohort (M = 2.55, SD = 3.74; p = &amp;lt;0.001); as well as greater symptom severity (M = 7.75 SD = 11.45) compared to the pre-pandemic cohort (M = 4.34, SD = 7.9; p = &amp;lt;0.001). Greatest endorsement differences were observed in anxiety, depression, cognitive, nausea, and “don‚Äôt feel right”symptoms (ps &amp;lt; 0.001). However, frequency of mild to severe symptom reporting was similar on the PHQ-9 (pre-pandemic: 23.6%, post-pandemic: 20.3%) and GAD-7 (pre-pandemic: 20.9%, post-pandemic: 21.6%; ps &amp;gt;0.05). Conclusions Post-pandemic athletes appear to endorse greater baseline symptoms of anxiety and depression, as well as cognitive and physical symptoms, though these do not appear to meet clinical levels. The study demonstrates a need to improve surveillance in varsity athletes’MH that may help identify athletes at risk of MH illness.

A - 27 A Preliminary Investigation of the Relationship between Sleep Symptoms and Post-Concussion Cognitive Performance in Adolescents

Abstract Purpose To explore the relationship between self-reported sleep symptoms and post-concussion cognitive test performance in adolescents on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Method 54 adolescents (ages 12–16) referred to a specialized sports concussion private practice completed post-concussion ImPACT. Five symptom clusters were derived from the post-concussion symptom scale: sleep, physical, cognitive, affective, and headache. Two-factor cognitive composites from the ImPACT (memory and speed) were the outcome variables. Multivariate linear regression was conducted to examine the relationship between cognitive variables and sleep symptoms. Post-hoc forward stepwise linear regressions were used to explore the following potential additional predictors of cognitive outcomes: age, number of previous concussions, sex, hours slept the night before, and five symptom clusters. Results Sleep symptoms were significantly associated with cognitive performance, F(1,52) = 9.95, p &amp;lt; 0.001, ƞ2 = 0.28. Higher sleep symptom cluster scores were associated with worse memory, F(1,53) = 13.68, p &amp;lt; 0.001, ƞ2 = 0.21, and speed performance, F(1,53) = 17.84, p &amp;lt; 0.001, ƞ2 = 0.26. Results of post-hoc forward stepwise linear regressions revealed that a final model for speed performance included only the sleep symptom cluster, explaining 16.6% of the variance. The final model for memory performance included only the headache rating, explaining 20.1% of the variance. Conclusions Our results indicate that severity of self-reported sleep symptoms post-concussion are associated with cognitive performance in domains of memory and speed. After considering additional predictors, more severe sleep symptoms were significantly associated with worse speed performance and worse headache severity was significantly associated with memory performance.

A - 49 Predictors of Post-Concussion Anxiety In Patients without Pre-Existing Anxiety History

Abstract Purpose Identify factors contributing to anxiety in individuals without a pre-existing anxiety history post-concussion. Method Patients (n = 264, aged 9–68) presented to a specialty concussion clinic post-concussion. They completed a clinical interview, Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profile Screening (CP-Screen), and Vestibular/Ocular-Motor Screening (VOMS). Anxiety group was determined by a positive anxiety/mood clinical profile on CP-Screen. Independent samples t-tests and chi-square tests examined differences in demographics, medical history, and injury characteristics between groups. Univariate logistic regressions (LR) informed a follow-up forward stepwise LR to identify best predictors of post-concussion anxiety group. Receiver operating characteristic (ROC) analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best-discriminated anxiety status. Statistical significance was set a priori at p &amp;lt; 0.05. Results Results of forward stepwise LR identifying factors contributing to post-concussion anxiety were significant (p &amp;lt; 0.001) and accounted for 19% of the variance. The model accurately classified 82.2% of patients, with non-Sport Related Concussion (SRC) (OR = 2.94, 95%CI, 1.45–1.5.98, p = 0.003), history of ADHD/LD (OR = 2.85, 95%CI, 1.21–6.71, p = 0.02), positive vestibular profile (OR = 2.14, 95%CI, 1.06–4.33, p = 0.03), and days to first clinic visit (OR = 1.01, 95%CI, 1.01–1.015, p = 0.003) as significant predictors. ROC analysis of the AUC of this 4-factor model discriminated post-concussion anxiety from no anxiety (AUC, 0.77, 95%CI, 0.71–0.85, p &amp;lt; 0.001). Conclusions Findings suggest that non-SRC, ADHD/LD history, positive vestibular profile, and delayed clinic visit, may contribute to post-concussion anxiety among patients without prior anxiety history. These predictors may guide clinicians in tailoring interventions to optimize recovery outcomes.

Relationships Among Baseline Concussion Balance Test and Gaze Stability Test Scores in Division-I Collegiate Athletes.

Sports-related concussions are commonly occurring injuries as a result of sports and recreation that may cause alterations in brain functioning. It is important to be able to evaluate the impact of these injuries on function to manage the injury recovery and ensure recovery. Recent literature suggests the use of objective evaluation strategies in a multifaceted approach to evaluate and manage these injuries. It is important to understand the relationships between the assessments and how best to utilize each assessment. The purpose of this study was to investigate if relationships exist between measures of vestibular function at baseline in assessments that may be used following sports-related concussions. Additionally, a secondary purpose was to determine if self-reported symptoms were related to performance on the assessments. This study aimed to identify if these assessments measured independent functions of the vestibulo-ocular reflex or if some redundancy existed among the assessment strategies. A cross-sectional study design was used in a cohort of collegiate athletes ages 18-24. Participants completed demographics questionnaires, the Post-Concussion Symptom Scale, Gaze Stabilization Test, and Concussion Balance Test. Spearman rho correlations were used to examine the relationships between the measures. One hundred and thirty-five collegiate athletes (82 males and 53females) were included, representative of 3 sports (cheerleading, soccer, and football) with a mean age of 19.77 (1.42)years old. There were weak to moderate, significant relationships between measures of Gaze Stabilization Test and Concussion Balance Test errors (r = .20-.31, P = .001-.03). The direction of these relationships indicated that greater Concussion Balance Test errors were associated with greater Gaze Stabilization Test performance. These relationships may be attributed to the difficulty created by the foam conditions and the integration of more complex sensory tasks required to maintain balance during the more difficult conditions.

Acute psychological symptom profiles in high school athletes following sport-related concussion.

Psychological symptoms following a sport-related concussion may affect recovery in adolescent athletes. Therefore, the aims of this study were to 1) describe the proportion of athletes with acute psychological symptoms, 2) identify potential predictors of higher initial psychological symptoms, and 3) determine whether psychological symptoms affect recovery in a cohort of concussed high school athletes. A retrospective cohort study of high school athletes (14-18 years of age) who sustained a sport-related concussion from November 2017 to April 2022 and presented to a multidisciplinary concussion center was performed. The main independent variable was psychological symptom cluster score, calculated by summing the four affective symptoms on the initial Post-Concussion Symptom Scale (PCSS) (i.e., irritability, sadness, nervousness, feeling more emotional). The psychological symptom ratio was defined as the ratio of the psychological symptom cluster score divided by the total initial PCSS score. The outcomes included time to return to learn (RTL), symptom resolution, and time to return to play (RTP). Univariable and multivariable regressions were performed to adjust for demographic factors and health history. A total of 431 athletes (58.0% female, mean age 16.2 ± 1.3 years) were included. Nearly half of the sample (45%) reported at least one psychological symptom, with a mean psychological symptom cluster score of 4.2 ± 5.2 and psychological symptom cluster ratio of 0.10 ± 0.11. Irritability was the most commonly endorsed psychological symptom (38.1%), followed by feeling more emotional (30.2%), nervousness (25.3%), and sadness (22.0%). Multivariable regression showed that female sex (B = 2.15, 95% CI 0.91-3.39; p < 0.001), loss of consciousness (B = 1.91, 95% CI 0.11-3.72; p = 0.037), retrograde/anterograde amnesia (B = 1.66, 95% CI 0.20-3.11; p = 0.026), and psychological history (B = 2.96, 95% CI 1.25-4.70; p < 0.001) predicted an increased psychological symptom cluster score. Female sex (B = 0.03, 95% CI 0.00-0.06; p = 0.031) and psychological history (B = 0.06, 95% CI 0.02-0.10; p = 0.002) predicted an increased psychological symptom ratio. Multivariable linear regression showed that both higher psychological symptom cluster score and ratio were associated with longer times to RTL, symptom resolution, and RTP. In a cohort of high school athletes, 45% reported at least one psychological symptom, with irritability being most common. Female sex, loss of consciousness, amnesia, and a psychological history were significantly associated with an increased psychological symptom cluster score. Higher psychological symptom cluster score and psychological symptom ratio independently predicted longer recovery. These results reinforce the notion that psychological symptoms after concussion are common and may negatively impact recovery.

Does early exercise intolerance effect time to return to play, symptom burden, neurocognition, Vestibular-Ocular-Motor (VOM) function and academic ability in acutely concussed student-athletes?

ABSTRACT Introduction Early Exercise Intolerance (EEI) is associated with delayed recovery and longer time to Return To Play (RTP), but this has not been established. Participants; (n = 52, male n = 30) UK university-aged rugby-union student-athletes. Methods Student-athletes completed baseline screening (July–October 2021 and 2022). The test battery was repeated within 48 h, 4, 8 and 14 days after a Sports-Related Concussion (SRC) with the Buffalo Concussion Bike or Treadmill Test to set sub-symptom heart rate threshold. Student-athletes then completed a controlled early exercise protocol in-between reassessment (days 3, 5–7 and 9–13). Those with EEI were compared to those with early-exercise tolerance. Outcome measures Post-Concussion Symptom Scale, Immediate Post-Concussion and Cognitive Test, Vestibular-Ocular Motor Screening Tool and the Revised Perceived Academic Impact Tool. Results EEI was seen throughout the initial 14-days post-SRC (23.8%, 22.4%, 25.5%. 25.0%). EEI was associated with a slower reaction time within 48 h (−0.01 (−0.030–0.043) Vs 0.06 (0.033–0.24), p = 0.004) and greater VOMS scores within 48 h; (0.00 (0.00–4.00) Vs 5.50 (2.75–9.00), p = 0.016) and 4 days (0.00 (0.00–2.00) Vs 5.00 (0.00–6.00), p = 0.044). RTP was 12.5 days longer in those with EEI at 14-days post-SRC. Conclusion EEI is prevalent following an SRC in university-aged student-athletes and was associated with delayed recovery and RTP.