Background: The Post-Concussion Symptom Scale (PCSS) is a self-report questionnaire measuring symptoms that commonly occur after a concussion; however, these symptoms are nonspecific and can be related to co-occurring orthopaedic injuries (eg, cervical strain) or patient characteristics and preexisting conditions, even in the absence of a recent injury. As such, clinicians may have difficulty determining whether symptom elevations are attributable to a recent concussion as opposed to a confounding injury or a preexisting condition, which may be especially difficult when preinjury baseline symptom data are unavailable. Purpose: This study aimed to further validate the 4-factor model of the PCSS (ie, cognitive, sleep-arousal, physical, and affective symptoms) with adolescent student-athletes and provide normative reference data for each factor and the total score, stratified by gender and preexisting health conditions. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants were 9358 adolescent student-athletes who completed the PCSS during a preseason baseline evaluation (mean age, 14.9 years; SD, 1.3 years [range, 13-18 years]; 49.3% boys). The 4-factor model of the PCSS was tested for the full sample and separately for boys and girls using confirmatory factor analysis. Symptom severity percentiles were created for the PCSS total score and each factor, stratified by gender and preexisting conditions (ie, attention-deficit/hyperactivity disorder, mental health history, headache/migraine history, learning disability/dyslexia, academic problems, and concussion history). Results: The 4-factor model of the PCSS replicated in the full sample (comparative fit index [CFI] = 0.959) and in both gender groups (boys: CFI = 0.961; girls: CFI = 0.960). The total PCSS score at the 84th percentile varied by preexisting conditions as follows: healthy participants = 8, attention-deficit/hyperactivity disorder = 18, mental health history = 26, headache/migraine history = 18, learning disability = 19, and academic problems = 17. On all PCSS subscales, participants with a mental health history had the highest scores, and high scores were associated with having >1 preexisting condition. Girls had higher scores than boys for each stratification. Conclusion: The 4-factor model of the PCSS replicates for adolescent student-athletes. Gender, number of preexisting conditions, and mental health history are important factors to account for when interpreting PCSS symptom severity. The normative data provided herein could assist clinicians in determining whether an adolescent student-athlete is presenting with persistent postconcussion symptoms or a typical symptom experience based on their gender and personal health history.
The Post-Concussion Symptom Scale (PCSS) measures cognitive, sleep-arousal, physical, and affective symptoms that typically follow sport-related concussion (SRC). Mental health symptoms are associated with postconcussion-like symptoms, regardless of concussion status. This study examined whether mental health or SRC history had a stronger relation with symptom reporting and investigated the association between PCSS scores and perceived academic functioning. College students (N = 554) reported SRC history, current anxiety and depression symptoms, and academic self-efficacy. Participants were divided into healthy, SRC, anxiety, and depression groups then compared on individual symptom endorsement, symptom severity (total score and subscales), and academic self-efficacy. Healthy participants had lower endorsement rates than the anxiety/depression groups on all PCSS items (ps < .001) but vomiting, and lower symptom severity on each PCSS subscale and the total score (ps < .001, d range = .89 to 1.86). The healthy and SRC groups differed on only one item (i.e., trouble falling asleep, p < .001), one subscale (sleep-arousal, p < .01, d = .33), and the total score (p < .01, d = .27), with subtly greater severity in the SRC group. The cognitive subscale had the strongest relation with academic self-efficacy for every group (rho range = −.23 to −.36). Larger differences emerged when comparing healthy participants to those screening positive for anxiety/depression than those with an SRC history, indicating current mental health has a stronger relation with postconcussion-like symptoms than remote SRCs. Cognitive symptoms were strongly associated with perceived academic ability. In college students with a history of SRC, mental health symptoms may explain lasting symptoms and necessitate intervention for academic performance.
Purpose Develop baseline normative reference data for the Sport Concussion Assessment Tool-3 (SCAT-3) Symptom Evaluation and examine how sex and preexisting conditions relate to the symptom domains endorsed by collegiate athletes. Methods Participants (N=24,696 collegiate student-athletes; 62.6% Male, 61.5% White, 9.2% Hispanic or Latino) from the Concussion Assessment, Research, and Education Consortium completed the SCAT-3 at a preseason baseline. Using a four-factor model (i.e., cognitive, physical, affective, and sleep-arousal), normative percentiles were calculated for each symptom subscale and the total score, with stratifications by sex and number of preexisting conditions. Symptom score distributions were compared across stratifications using Mann-Whitney U tests. Results Generally, female athletes and those with more preexisting conditions endorsed significantly higher symptoms at baseline (e.g., 84th percentile affective score: males=1, females=3, p<.001, r=.14; females with 1 condition=4, 3+ conditions=8, p<.001, r=11; males with 1 condition=3, 3+ conditions=7, p<.01, r=.06). This pattern held for all but the physical (i.e., no difference between individuals with 1 and 3+ conditions) and sleep-arousal (i.e., no difference between males with 1 and 3+ conditions) subscales. Conclusions Female sex and preexisting conditions were associated with higher symptom burden on most subscales. A female athlete with a symptom score of 10 may appear to have elevated post-concussion symptoms; however, if she has 3 preexisting conditions, this experience is average (i.e., 50th percentile) compared to others with 3+ conditions at baseline. She may benefit from intervention, but symptoms may not be attributable to a concussion. Normative reference data may help indicate symptom severity when baseline data are unavailable.
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