Objective To evaluate the role of time since injury on the factor structure of the Post-Concussion Symptom Scale (PCSS) for athletes after sustaining a sport-related concussion (SRC). Methods Adolescent athletes (n = 782) were dichotomized based on time since injury: 0–7 (EARLY; n = 321, age: 15.4 ± 1.9 years, 51.7% female), 8–14 (MIDDLE; n = 281, age: 15.8 ± 2.2 years, 54.8% female) and 15–30 days (LATE; n = 180, age: 15.6 ± 1.8 years, 52.8% female). An EFA was performed on the 22 variables of the PCSS for each of the three cohorts (primary factor loading of 0.6 to retain each item). Results EARLY had a five-component model (64% of total variance): 1) GLOBAL (18.0%; headache/dizziness/photosensitivity/phonosensitivity/difficulty concentrating), 2) FATIGUE/HYPERSOMNIA (16.4%; fatigue/drowsiness/mental fogginess/slowed down/hypersomnia), 3) AFFECTIVE (12.6%; more emotional/sadness), 4) INSOMNIA (9.0%; insomnia/trouble falling asleep), 5) SOMATIC (8.0%; vomiting/numbness). MIDDLE had a four-component model (63.1% of variance): 1) GLOBAL (19.4%; photosensitivity/headache/phonosensitivity/nausea/dizziness), 2) INSOMNIA/AFFECTIVE (14.4%; insomnia/more emotional/nervousness/trouble falling asleep), 3) SOMATIC/MEMORY (12.2%; difficulty remembering/numbness), and 4) HYPERSOMNIA (12.0%; drowsiness/hypersomnia). LATE had a four-component model (65.7% of variance): 1) VESTIBULAR/OCULAR (18.2%; vision/difficulty remembering/balance/fogginess/dizziness), 2) MIGRAINE (16.6%; photosensitivity/phonosensitivity/fatigue/headache), 3) AFFECTIVE (16.1%; sadness/nervousness/more emotional), and 4) INSOMNIA (7.6%; insomnia/trouble falling asleep). Conclusions The results of this study suggest greater time since injury modifies symptom factor structure in adolescent athletes with SRC. Specifically, symptom factors become more distinct with longer time since injury before first clinical visit. A GLOBAL symptom factor was observed for both EARLY and MIDDLE, but not in LATE. SOMATIC (i.e., numbness) was observed in EARLY/MIDDLE, but not LATE. Symptom factors in LATE seem to mirror concussion clinical sub-types from previous research (e.g., vestibular/ocular, migraine, affective, sleep).
Objective The objective of the current study was to examine differences in clinical outcomes between adolescents’ first, second, and third concussions. Methods We conducted a retrospective medical chart review of adolescents (n = 40) aged 10–19 years-old (M = 13.0;SD = 1.9;56% male) who presented for evaluation of concussion at a specialty clinic for their first (Concussion 1 = C1), second (C2), and third (C3) concussions. Clinical outcomes included Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Vestibular/Ocular-Motor Screening (VOMS) scores from the first clinic visit for each injury, recovery time, and days between injuries. Paired samples t-tests were conducted to compare outcomes between concussions. Results When comparing initial presentation between C1 and C2, participants demonstrated no significant differences in ImPACT, PCSS (t[38] = 0.85, p = 0.402) or VOMS (t[34] = −0.75, p = 0.461), with the exception of faster Visual Motor Speed for C2 (t[38] = −3.45, p = 0.001). Participants demonstrated improved performance from C1 to C3 on ImPACT composites of Verbal Memory (t[38] = −4.22, p < 0.001), Visual Memory (t[38] = −2.99, p = 0.005), Visual Motor Speed (t[38] = −5.14, p < 0.001) and Reaction Time (t[38] = 0.11, p = 0.001). Symptom report was consistent on PCSS (t[38] = 1.80, p = 0.081) and VOMS (t[30] = −0.12, p = 0.903) between C1 and C3. Recovery time was similar comparing C1 to C2 (t[36] = −0.35,p = 0.725) and C1 to C3 (t[34] = 1.74,p = 0.090). Conclusions The results suggest adolescents demonstrate similar levels of symptoms, VOMS, and recovery time after first, second, and third concussions. Neurocognitive performance improved across C1 to C3, suggesting possible learning effect or improved performance with cognitive development. These results provide additional support for similarity between an athlete’s first and second concussion with further initial evidence that a third concussion does not result in worse outcomes.
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