Total Symptom Severity Score Research Articles

Symptom Burden in Patients on Maintenance Hemodialysis: Prevalence and Severity 17 Years Apart.

Objectives: The aim of this study is to compare data from two cohorts separated by a 17-year interval. We assessed the prevalence and severity of symptoms with the "dialysis symptom index" in these two groups, recruited in 2007 and 2024, to determine how advancements in dialysis therapy have influenced the symptom burden's prevalence and severity. Methods: End-stage renal diseases patients receiving maintenance hemodialysis three times a week in the hemodialysis unit of the university hospital were recruited between February and March 2007. In May 2024, in the same unit, another population sample was recruited and studied, as in 2007. The Dialysis Symptom Index (DSI) was administered to each patient, during the dialysis treatment. The DSI is made up of 30 questions, each of which addresses a specific physical or emotional symptom. The total symptom burden score, representing the total number of symptoms reported as being present, and the total symptom severity score, which represents the sum of individual severity scores, were generated for each patient. Results: We studied 71 patients in 2007 and 61 patients in 2024. The demographic, clinical and laboratory characteristics of the two study populations did not differ significantly. The total symptom burden score did not differ significantly between 2007 and 2024. The prevalence of most symptoms was similar in the two groups. The prevalence of constipation, decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. The total symptom severity was similar in the two periods. The severity of most symptoms was similar in the two groups. The severity of decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. Conclusions: The present study shows that, 17 years apart, the prevalence and severity of the symptom burden in patients on maintenance hemodialysis did not change significantly. These results suggest that studies investigating the causes and the pathogenesis of symptoms of patients on maintenance hemodialysis are urgently needed in the next future, as well as studies on therapeutic strategies.

Topical Nasal Steroids for Allergic Rhinitis in Children. Is One Better Than the Others? Protocol for a Systematic Review and Network Meta-analysis.

Background The present protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO under de ID code CRD42023476313, and adheres the PRISMA-P 2015 statement. The complete checklist can be consulted in the extended data section. Allergic Rhinitis (AR) is the most common chronic disease in children worldwide. According to many guidelines topical nasal steroids (TNS) are the first-line treatment for moderate/severe AR in children, nevertheless there is no conclusive evidence about which of them is superior in terms of efficacy and safety, including their impact on child’s growth. Methods We will conduct a systematic review of randomized controlled trials evaluating TNS in the treatment of children with moderate/severe AR. The primary outcome is the efficacy measured with the Total Nasal Symptom Severity Score (TNSS). Secondary outcomes are quality of life, adverse events (AE), and growth velocity. We will search Medline, Embase, CENTRAL, LILACS, clinicaltrials.gov, WHO trials database and grey literature resources. Two reviewers will independently screen titles and abstracts, review full texts, extract information, and assess the risk of bias and the confidence in the estimate (with the grading of recommendations, assessment, development, and evaluation [GRADE] approach). We will conduct a random-effects NMA to combine the pooled direct and indirect treatment effect estimates for each outcome if adequate data is available and transitivity and coherence assumptions are considered justifiable. Subgroup and sensitivity analyses are planned to evaluate the impact of some potential effect modifiers such as doses, co-intervention with oral antihistamines, the type of AR (intermittent or persistent), sponsorship of the study, the time of outcomes measurement and the risk of bias. We will use GRADE approach to draw conclusions from NMA. Discussion This systematic review and network meta-analysis aims to determine the relative efficacy and safety of the TNS for treatment of children with moderate/severe AR. The results will provide valuable information to assist clinicians, guideline developers, patients, and policy makers about the management of these patients, based on the best available evidence. Systematic review registration: PROSPERO number: CRD42023476313.

Symptom Exacerbation and Adverse Events during a Randomized Trial of Early-stage Concussion Rehabilitation.

Few studies utilize randomized clinical trials (RCT) 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 Randomized Controlled Trial (XXX). 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), United States (U.S.)/Canadian colleges (n=128) and U.S. 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 a 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 (IQRs) were calculated for outcomes by treatment group. The 251 post-injury 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 equivilantly 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 pre- to post-session 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.

Cognitive, Sleep-Arousal, Physical, and Affective Domain Scores on the Post-Concussion Symptom Scale: Added Utility in Detecting Symptom Elevations among Student-Athletes with a Remote History of Concussion.

The evaluation of self-reported symptoms is a standard component of concussion assessment and management. Clinicians typically evaluate a total symptom severity score rather than scores corresponding to specific symptom domains (i.e., cognitive, sleep-arousal, physical, and affective symptoms). This study examined (i) whether elevations in specific symptom domains would be missed when interpreting only the total symptom severity score and (ii) if a single symptom domain elevation was more common than having elevated symptoms across multiple domains. Adolescent student-athletes (N = 1,008) with concussion history (i.e., ≥6months since last concussion) completed the Post-Concussion Symptom Scale (PCSS). The PCSS total score and cognitive, sleep-arousal, physical, and affective domain scores were calculated. To determine if symptoms were elevated, scores were compared to normative data matched on gender and pre-existing conditions, with scores considered elevated if they were ≥84th percentile. The frequency of total and domain score elevations were calculated and stratified by gender and number of prior concussions (i.e., 1 or ≥2 prior concussions). Overall, 26% of student-athletes had an elevated symptom domain score without being elevated on the total score. The most common symptom presentation was to have a single elevated symptom domain (21%), followed by two (11%), three (8%), or four elevated domains (6%). Interpreting PCSS symptom domains may be beneficial in detecting student-athletes with elevated symptoms following a remote concussion. Roughly a quarter of student-athletes have domain-specific symptom elevations that would be missed by interpreting the total score alone.

The Influence of the COVID-19 Pandemic on Baseline Concussion Symptom Assessments Among Adolescents.

Introduction The COVID-19 pandemic resulted in the cancellation of high school sports in spring 2020, a modified resumption of sports in the 2020-2021 academic year, and a return to pre-pandemic sports in 2021-2022. This cancellation had a major impact on the quality of life of adolescent athletes, but it is unknown exactly how these pandemic-driven sports disruptions on athlete baseline (preseason) symptoms affected quality of life. Therefore, the current study retrospectively evaluated symptom inventories from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assessments to determine whether the cancellation of sports during the COVID-19 pandemic affected baseline (preseason) self-reported symptoms among adolescent athletes. Methods Our study used a retrospective cohort design to evaluate high school athletes with complete ImPACT assessments in the academic years before (2018-2019 and 2019-2020), during (2020-2021), and after (2021-2022) the pandemic. Specifically, data from a 22-item symptom report called the Post-Concussion Symptom Scale (PCSS) assessed during ImPACT was collected and analyzed using generalized linear models with a Tweedie exponential dispersion model and post hoc Tukey's honestly significant difference tests. The main outcomes were the total symptom severity score and the affective cluster score. Secondary outcomes were the analysis of the vestibular-somatic, cognitive-sensory, and sleep-arousal symptom clusters. Results Of the 104,274 ImPACT assessments, the total symptom severity score on the PCSS was different across years (p<0.001). There were lower symptom scores in 2020-2021 (5.33, 95% CI = 5.13-5.54) than in 2018-2019 (6.82, 95% CI = 6.63-7.01), 2019-2020 (6.94, 95% CI = 6.75-7.14), and 2021-2022 (6.44, 95% CI = 6.25-6.64). The cluster scores on the PCSS for affective, cognitive-sensory, sleep-arousal, and vestibular-somatic were also lower (p<0.001) in 2020-2021 than in 2018-2019, 2019-2020, and 2021-2022. Conclusion Contrary to our expectations, total symptom severity and cluster scores on the PCSS during the pandemic (2020-2021) were significantly lower than during the years before and after the pandemic-driven sports disruptions, suggesting the pandemic did not negatively affect these athletes as expected. These results also suggested that self-reported symptoms utilized in the PCSS component of ImPACT may not be as sensitive to sports disruption among adolescent athletes as other quality-of-life measures, especially during the COVID-19 pandemic.

Impact of Playing Surface on Concussion Symptoms in Young American Football Players.

It has been suggested that sport-related concussion (SRC) occurs more commonly on natural grass compared with artificial turf in contact sports. As playing surface is a potentially modifiable risk factor, this study sought to identify differences in symptoms following SRC on these 2 surfaces in a sample of young American football players. Prospective. Part of the multi-institutional North Texas Concussion Registry (ConTex) research project. Ten-year-old to 24-year-old male American football players (n = 62) who had sustained a helmet-to-ground SRC and presented to a specialty concussion clinic within 14 days of injury. Helmeted impact with grass (n = 33) or artificial turf (n = 29). Severity and number of symptoms endorsed on the Sport Concussion Assessment Tool 5th Edition (SCAT5) Symptom Evaluation at the time of initial clinical evaluation. Both groups were similar in mean time since injury, concussion history, and history of headache, but the artificial turf group was slightly older, with a mean age of 14.6 versus 13.6 years ( P = 0.039). Athletes who sustained a SRC on grass reported significantly higher mean total symptom severity scores (26.6 vs 11.6, P = 0.005) and total number of symptoms (10.3 vs 5.9, P = 0.006) compared with those who were injured on artificial turf. This may be the first study to examine postconcussive symptoms after SRC as they relate to playing surface. This small sample of young American football players reported higher symptom severity scores and higher total number of symptoms after SRC on natural grass compared with artificial turf.

Telomere Length Associates With Symptom Severity After Mild Traumatic Brain Injury in Older Adults.

The objectives were to compare differences in telomere length (TL) among younger (21-54 years) and older adults (≥55) with mild traumatic brain injury (mTBI) to non-injured controls and to examine the association between TL and the severity of post-concussive symptoms over time. We performed a quantitative polymerase chain reaction to determine the TL (Kb/genome) of peripheral blood mononuclear cell samples (day 0, 3 months, and 6 months) from 31 subjects. The Rivermead Post-Concussion Symptoms Questionnaire was used to assess symptoms. Group-by-time comparisons of TL and symptom severity were evaluated with repeated-measures analysis of variance. Multiple linear regression examined the relationship between TL, group (mTBI and non-injured controls), and symptom severity total and subscale scores. Significant aging-related differences in TL were found within mTBI groups by time (day 0, 3 months, and 6 months; p = 0.025). Older adults with mTBI experienced significant worsening of changes in total symptom severity scores over time (day 0, 3 months, and 6 months; p = 0.016). Shorter TLs were associated with higher total symptom burden among each of the four groups at day 0 (baseline; p = 0.035) and 3 months (p = 0.038). Shorter TL was also associated with higher cognitive symptom burden among the four groups at day 0 (p = 0.008) and 3 months (p = 0.008). Shorter TL was associated with higher post-injury symptom burden to 3 months in both older and younger persons with mTBI. Large-scale, longitudinal studies of factors associated with TL may be useful to delineate the mechanistic underpinnings of higher symptom burden in adults with mTBI.

A Mendelian randomization study of genetic liability to post-traumatic stress disorder and risk of ischemic stroke

Observational studies have shown an association between post-traumatic stress disorder (PTSD) and ischemic stroke (IS) but given the susceptibility to confounding it is unclear if these associations represent causal effects. Mendelian randomization (MR) facilitates causal inference that is robust to the influence of confounding. Using two sample MR, we investigated the causal effect of genetic liability to PTSD on IS risk. Ancestry-specific genetic instruments of PTSD and four quantitative sub-phenotypes of PTSD, including hyperarousal, avoidance, re-experiencing, and total symptom severity score (PCL-Total) were obtained from the Million Veteran Programme (MVP) using a threshold P value (P) of <5 × 10−7, clumping distance of 1000 kilobase (Mb) and r2 < 0.01. Genetic association estimates for IS were obtained from the MEGASTROKE consortium (Ncases = 34,217, Ncontrols = 406,111) for European ancestry individuals and from the Consortium of Minority Population Genome-Wide Association Studies of Stroke (COMPASS) (Ncases = 3734, Ncontrols = 18,317) for African ancestry individuals. We used the inverse-variance weighted (IVW) approach as the main analysis and performed MR-Egger and the weighted median methods as pleiotropy-robust sensitivity analyses. In European ancestry individuals, we found evidence of an association between genetic liability to PTSD avoidance, and PCL-Total and increased IS risk (odds ratio (OR)1.04, 95% Confidence Interval (CI) 1.007–1.077, P = 0.017 for avoidance and (OR 1.02, 95% CI 1.010–1.040, P = 7.6 × 10−4 for PCL total). In African ancestry individuals, we found evidence of an association between genetically liability to PCL-Total and reduced IS risk (OR 0.95 (95% CI 0.923–0.991, P = 0.01) and hyperarousal (OR 0.83 (95% CI 0.691–0.991, P = 0.039) but no association was observed for PTSD case-control, avoidance, or re-experiencing. Similar estimates were obtained with MR sensitivity analyses. Our findings suggest that specific sub-phenotypes of PTSD, such as hyperarousal, avoidance, PCL total, may have a causal effect on people of European and African ancestry’s risk of IS. This shows that the molecular mechanisms behind the relationship between IS and PTSD may be connected to symptoms of hyperarousal and avoidance. To clarify the precise biological mechanisms involved and how they may vary between populations, more research is required.

A-18 Indicators of Behavioral Symptom Management Strategy Adherence in Collegiate Athletes with Concussions

Abstract Purpose This study explores indicators of post-concussive behavioral symptom management strategy adherence in collegiate athletes. Methods Behavioral Symptom Management Strategy Recommendations were provided to 34 collegiate athletes (23 males, 11 females, ages: 18-22) at post-injury. At follow-up, athletes rated strategy adherence in overall frequency (never, rarely, sometimes, often, almost always). Athletes were administered the Sport Concussion Assessment Tool-5th Edition (SCAT-5) at post-injury and follow-up. Participant data was grouped by adherence frequency: Low (never-rarely, N=7), Moderate (sometimes, N=5), and High (often-almost always, N=22). Increases in SCAT-5 Total Symptom Score (TSS) and Symptom Severity Score (SSS) were calculated by subtracting baseline scores from post-injury scores. Score change outliers and instances in which baseline scores were higher than post-injury scores were removed. Results An overall significant mean difference in TSS and SSS changes from baseline to post-injury among adherence frequencies was found, F(2,31)=4.45, p=.02, F(2,31)=4.40, p=.021. Post-hoc tests (Tukey) demonstrated that increases in TSS from baseline to post-injury were significantly higher in athletes with High (M=8.73, SD=5.28, p=.03) and Moderate (M=10.40, SD=5.22, p=.039) adherence frequency compared to those with Low (M=3.00, SD=2.94). Similar effects were demonstrated for increases in SSS for High (M=21.77, SD=18.04, p=.043) and Moderate (M=29.80, SD=19.31, p=.029) compared to Low (M=3.71, SD=3.59). A significant correlation was found between adherence frequency and number of previous concussions, r=.39, p=.025. Conclusions Results suggest that greater increases in SCAT-5 TSS and SSS from baseline to post-injury and number of previous concussions are associated with a higher frequency of adherence to post-concussive behavioral symptom strategy recommendations in collegiate athletes.

Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids

Few studies have directly compared different surgical procedures for uterine fibroids with respect to long-term health-related quality of life outcomes and symptom improvement. We examined differences in change from baseline to 1-, 2-, and 3-year follow-up in health-related quality of life and symptom severity among patients who underwent abdominal myomectomy, laparoscopic or robotic myomectomy, abdominal hysterectomy, laparoscopic or robotic hysterectomy, or uterine artery embolization. The COMPARE-UF registry is a multiinstitutional prospective observational cohort study of women undergoing treatment for uterine fibroids. A subset of 1384 women aged 31 to 45 years who underwent either abdominal myomectomy (n=237), laparoscopic myomectomy (n=272), abdominal hysterectomy (n=177), laparoscopic hysterectomy (n=522), or uterine artery embolization (n=176) were included in this analysis. We obtained demographics, fibroid history, and symptoms by questionnaires at enrollment and at 1, 2, and 3 years posttreatment. We used the UFS-QoL (Uterine Fibroid Symptom and Quality of Life) questionnaire to ascertain symptom severity and health-related quality of life scores among participants. To account for potential baseline differences across treatment groups, a propensity score model was used to derive overlap weights and compare total health-related quality of life and symptom severity scores after enrollment with a repeated measures model. For this health-related quality of life tool, a specific minimal clinically important difference has not been determined, but on the basis of previous research, a difference of 10 points was considered as a reasonable estimate. Use of this difference was agreed upon by the Steering Committee at the time when the analysis was planned. At baseline, women undergoing hysterectomy and uterine artery embolization reported the lowest health-related quality of life scores and highest symptom severity scores compared with those undergoing abdominal myomectomy or laparoscopic myomectomy (P<.001). Those undergoing hysterectomy and uterine artery embolization reported the longest duration of fibroid symptoms with a mean of 6.3 years (standard deviation, 6.7; P<.001). The most common fibroid symptoms were menorrhagia (75.3%), bulk symptoms (74.2%), and bloating (73.2%). More than half (54.9%) of participants reported anemia, and 9.4% women reported a history of blood transfusion. Across all modalities, total health-related quality of life and symptom severity score markedly improved from baseline to 1-year with the largest improvement in the laparoscopic hysterectomy group (Uterine Fibroids Symptom and Quality of Life: delta= [+] 49.2; symptom severity: delta= [-] 51.3). Those undergoing abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization also demonstrated significant improvement in health-related quality of life (delta= [+]43.9, [+]32.9, [+]40.7, respectively) and symptom severity (delta= [-]41.4, [-] 31.5, [-] 38.5, respectively) at 1 year, and the improvement persisted from baseline for uterine-sparing procedures during second (Uterine Fibroids Symptom and Quality of Life: delta= [+]40.7, [+]37.4, [+]39.3 SS: delta= [-] 38.5, [-] 32.0, [-] 37.7 and third year (Uterine Fibroids Symptom and Quality of Life: delta= [+] 40.9, [+]39.9, [+]41.1 and SS: delta= [-] 33.9, [-]36.5, [-] 33.0, respectively), posttreatment intervals, however with a trend toward decline in degree of improvement from years 1 and 2. Differences from baseline were greatest for hysterectomy; however, this may reflect the relative importance of bleeding in the Uterine Fibroids Symptom and Quality of Life, rather than clinically meaningful symptom recurrence among women undergoing uterus-sparing treatments. All treatment modalities were associated with significant improvements in health-related quality of life and symptom severity reduction 1-year posttreatment. However, abdominal myomectomy, laparoscopic myomectomy and uterine artery embolization indicated a gradual decline in symptom improvement and health-related quality of life by third year after the procedure.

Transcendental Meditation for Women Affected by Domestic Violence: A Pilot Randomised, Controlled Trial

Abstract Purpose Domestic and family violence is a major public health issue impacting one in three women worldwide. The implications of such violence are considerable. Transcendental Meditation® (TM) represents a promising treatment option for women impacted by domestic violence given its demonstrable effects on mental and trauma-related symptoms. This study set out to compare the effectiveness of TM to group support, on quality of life, perceived stress and mood in female survivors of domestic violence. Methods This 16-week pilot randomised controlled trial recruited women from metropolitan Adelaide, who survived any type of domestic violence in their lifetime. Outcomes included health-related quality of life, severity of depression, anxiety and perceived stress, symptoms of post-traumatic stress disorder, and subjective experience. Data were analysed by intention-to-treat using linear mixed-effects models. Results Forty-two women were randomly assigned to the TM (n = 21) and support (n = 21) groups. Adjusting for random effects, TM was shown to be significantly more effective than support at improving Australian Quality of Life (AQoL-8D) utility scores (p = .011), and Depression Anxiety and Stress Scale (DASS-21) severity scores for depression (p = .029), anxiety (p = .017) and stress (p = .021) over the 16 weeks. There was no statistically significant time-group interaction effect for PTSD Checklist for DSM-5 (PCL-5) total symptom severity scores. Conclusions TM is shown to have promising effects on quality of life, perceived stress and mood among women exposed to domestic violence, suggesting that it may represent an effective alternative to group support. Trial Registration ACTRN12620000467932 (09/04/2020).

Acute effects of concussion among adolescents with attention-deficit/hyperactivity disorder

ABSTRACT Adolescents with ADHD have a greater lifetime history of concussion and experience concussion-like symptoms in the absence of a concussion, complicating concussion assessment and management. It is well established that individuals who experience greater acute symptoms following concussion are at risk for slower recovery and persistent symptoms. We examined whether youth with ADHD experience worse acute effects, within the first 72 h following concussion, compared to youth without ADHD. We hypothesized that youth with ADHD would perform worse on neurocognitive testing and endorse more severe symptoms acutely following injury, but the magnitude of change from pre injury to post injury would be similar for both groups, and thus comparable to baseline group differences. The sample included 852 adolescents with pre-injury and post-injury ImPACT results (within 72 h); we also conducted supplementary case-control analyses on a subset of youth with and without ADHD matched on demographics and pre-injury health history. For both samples, there were significant interaction effects for the Verbal Memory and Visual Motor Speed composites (p < 0.01, η 2 =.01–.07, small-medium effect), such that youth with ADHD showed a greater magnitude of diminished cognitive functioning from pre-injury to post-injury testing. There were no significant differences in the magnitudes of changes from pre injury to post injury with regard to overall symptom reporting (i.e., total symptom severity scores, total number of symptoms endorsed); however, there were group differences in endorsement rates for several individual symptoms. Further research is needed to determine whether such differential acute effects are associated with recovery time in youth with ADHD.

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.

Saliva Cortisol as a Biomarker of Injury in Youth Sport-Related Concussion.

Increasing rates of sport-related concussion (SRC) in youth impose a significant burden on public health systems and the lives of young athletes. Accurate prediction for those likely to develop persistent post-concussion symptomology (PPCS) using a fluid biomarker, reflecting both acute injury and recovery processes, would provide the opportunity for early intervention. Cortisol, a stress hormone released through the hypothalamic-pituitary-adrenal (HPA) axis following injury, may provide a missing physiological link to clinical recovery. This cohort study investigated the change in saliva cortisol following SRC and the association between cortisol and symptom burden in pediatric ice hockey players. Further, the association between cortisol levels and medical clearance to return to play was explored. In total, cortisol samples from 233 players were included; 165 athletes (23.6% female) provided pre-injury saliva and 68 athletes (19.1% female) provided post-SRC saliva samples for cortisol analysis. Quantile (median) regressions were used to compare cortisol between pre-injury and post-SRC groups, and the association between total symptoms (/22) and symptom severity scores (/132) reported on the Sport Concussion Assessment Tool (SCAT)3/SCAT5 and post-SRC cortisol (adjusting for age, sex, history of concussion, and time from injury to sample collection). Results demonstrated significantly lower saliva cortisol in post-SRC athletes compared with the pre-injury group (β = -0.62, 95% confidence interval [CI; -1.08, -0.16], p = 0.009). Post-SRC cortisol was not significantly associated with the SCAT3/SCAT5 symptom totals or symptom severity scores; however, females were found to report more symptoms (β = 6.95, 95% CI [0.35, 13.55], p = 0.040) and greater symptom severity (β = 23.87, 95% CI [9.58, 38.15], p = 0.002) compared with males. Exploratory time-to-event analysis revealed a point estimate suggesting a potential association between low cortisol levels and days to medical clearance to return to play. Although preliminary, these findings suggest that the HPA axis may be dysregulated post-SRC. Further, our exploratory analysis and case presentation of post-injury outliers highlight the need to further research cortisol as a prognostic biomarker to inform individualized sex-specific care after SRC.

Update on Posttraumatic Stress Disorder and Implications for Acute and Critical Care APRNs.

Update on Posttraumatic Stress Disorder and Implications for Acute and Critical Care APRNs.

A-223 Preliminary Investigation of Convergent Validity and Utility of the Texas Postconcussion Symptom Inventory

Abstract Objective: The Texas Postconcussion Symptom Inventory (TPSI) is a novel, 66-item, self-report instrument with empirically-derived indices that provides a summed total score to assess recovery following concussion. This study evaluated convergent validity of the TPSI with the Sport Concussion Assessment Tool Post-Concussion Symptom Scale (PCSS), and examined differences in symptom scores between recovered and non-recovered adults to assess its utility in measuring post-concussion symptoms. Method: Adults (N=37; Mage=41.6; Female=59.5%; White=89.2%) diagnosed with concussion were recruited from a larger concussion study (ConTex) to complete the TPSI and PCSS three months after initial clinical evaluation. Convergent validity was assessed using nonparametric correlation analyses between total symptom severity scores on the PCSS and TPSI for all subjects. Independent sample t-tests examined whether the TPSI total symptom score differed between the adults reporting lingering symptoms (N=19) and those who had recovered (N=18). Results: Total TPSI symptom score strongly correlated with the PCSS total symptom score (ρ = .867; p&amp;lt;.001). Non-recovered adults (MTPSI = 55.61; SDTPSI = 26.38) reported significantly higher symptom scores than recovered adults (MTPSI = 34.64; SDTPSI = 22.69) on the TPSI t(35) = 2.59, p = .014, d = 0.85, 95% CI, [4.53, 37.32]. Conclusion(s): The TPSI demonstrated strong convergent validity with a common clinical postconcussion symptom instrument and identified significant differences in symptom reporting between recovered and non-recovered adults after a concussion. Future research will build upon these preliminary results and determine the utility of the TPSI in the acute stage following concussion as well as in tracking recovery.

A-16 More than Total Symptom Severity: Identifying Subtypes of Persistent Post-Concussion Symptoms using Normative Data

Abstract Objective: Prior factor analyses have supported the multidimensionality of post-concussion symptoms, but the symptom total score is often interpreted alone in practice. This study examined the added value of norm-referenced post-concussion symptom subscales to detect different subtypes of symptom presentations following concussion. Method: Adolescent student-athletes (N = 1008; 15.3 ± 1.4 years-old; 66.7% boys) with one or more prior concussions, at least 6 months post injury, completed the Post-Concussion Symptom Scale at preseason baseline. Severity ratings on four symptom subscales (i.e., cognitive, sleep-arousal, physical, and affective) were compared to normative data matched on gender and preexisting health conditions. The frequencies at which participants were elevated on one or more symptom subscales were calculated. Results: In the total sample, 21% of student-athletes were elevated on only one symptom subscale, 11% on two subscales, 8% on three subscales, and 6% on four subscales. Among student-athletes with a single elevated subscale, all symptom domains had similar frequencies of elevation. No differences in symptom elevations were found based on gender or number of prior concussions. Conclusion(s): A single-domain symptom elevation was the most common post-concussion symptom presentation among a cohort of adolescent student-athletes, with 26% of student-athletes elevated on a single subscale but not the total symptom score. These findings indicate that there are subtypes of post-concussion symptom presentations that would be missed through an interpretation of a total symptom severity score alone.

A-23 Neurorehabilitation of Equestrians with Post-Concussive Syndrome Decreases Symptom Severity

Abstract Purpose: The literature shows the risk of concussion for equestrians is equivalent to or greater than athletes in contact sports with approximately half of all equestrians reporting one or more concussions in their career. Despite this, the majority of equestrians do not receive care for their concussion which can lead to chronic neuropsychological symptoms and post-concussion syndrome. Methods: A neurorehabilitation clinic treated 6 equestrians, 100% female with an average age of 40.5 years (+/−9.5), with post-concussion syndrome following head injuries received while riding. A 5-day, multi-modal neurorehabilitation program was administered in 10 one-hour treatment sessions. Each session consisted of a patient-specific combination of photobiomodulation, repetitive peripheral somatosensory stimuli, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, cognitive exercises, and/or off-vertical axis rotation utilizing a multi-axis rotational chair. Results: On intake, average overall symptom severity score of the SCAT5 graded symptom checklist was 44.17 (+/−23.90), and average severity of emotional domain symptoms (Nervousness/Anxiety, Irritability, Sadness, More Emotional) was 6.67 (+/−4.80). On exit, the average emotional domain symptom severity score decreased by 67.50% (2.17 +/−2.14) while the average total symptom severity score decreased by 57.74% (18.67 +/−14.60). Conclusions: The results show that neurorehabilitation was beneficial at decreasing overall symptom severity in equestrians with post-concussion syndrome, especially symptoms within the emotional domain. The authors suggest further research be performed with a more diverse and larger population and further concussion education be provided to equestrians to promote seeking care following a head injury.

A survey of Post-Traumatic Stress Disorder, Anxiety and Depression among Flood Affected Populations in Kerala, India.

BackgroundGlobally, post traumatic stress disorder (PTSD) is one of the most common psychiatric illnesses following a disaster. We aimed to evaluate the relationship between the socio-economic and flood exposure factors with PTSD, depression and anxiety among the flood-affected populations in Kerala, India.MethodsA cross-sectional household survey was conducted from November 2019 to January 2020 in Kozhikode district of Kerala, India. Adults (≥ 18 years), who were permanent residents and had been directly exposed to the flood, were invited to take part in the study. Individuals with a history of mental health issues and those who had other stressful situations in the past were excluded. The survey questionnaire was based on three screening tools: (1) PTSD Checklist for DSM-5 (PCL-5); (2) patient health questionnaire (PHQ-9); and (3) generalized anxiety disorder (GAD-7). Data included sociodemographic factors and flood exposure variables. The primary outcome variable was psychiatric morbidity (PTSD, anxiety and depression).ResultsA total of 276 respondents (150 males/126 females) participated in the study. A significant correlation was observed between total score on PCL-5 and GAD-7 (r=0.339, p=0.001) and PHQ-9 (r=0.262, p=0.001). Females had significantly higher total PTSD symptom severity scores (8.24±5.88 vs. 6.07±5.22; p=0.001), severity of symptoms of intrusion (4.66±3.60 vs. 3.69±3.20; p=0.04), increased level of anxiety (2.54±1.94 vs. 1.79±1.53; p=0.001) and depression (3.02±2.26 vs. 2.04±1.67; p=0.001) compared to males. However, the gender difference for PTSD symptoms disappeared when controlling for age.ConclusionThe findings of this survey revealed that the vast majority of respondents (92 percent females and 87 percent males) still had subclinical psychiatric symptoms one year after the flood. Therefore, tailored psychological interventions are warranted to counter the long-lasting impact of flooding on the mental health of individuals.

Correlation between Radiological and Total Nasal Symptom Severity Score Effect of Montelukast in Patient with Allergic Rhinitis Associated with Inferior Turbinate Hypertrophy

Correlation between Radiological and Total Nasal Symptom Severity Score Effect of Montelukast in Patient with Allergic Rhinitis Associated with Inferior Turbinate Hypertrophy