A novel approach to classifying postconcussion symptoms: The application of a new framework to the Post-Concussion Symptom Scale

Merritt, Victoria C.; Meyer, Jessica; Arnett, Peter A.

doi:10.1080/13803395.2015.1060950

Cited by 41 publications

(26 citation statements)

References 35 publications

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“…Moreover, there is concern over repeat concussions (Covassin et al 2013;Taylor et al 2018;Bruce and Echemendia 2004). Recently, CDC published on the diagnosis and treatment of concussion in children (Lumba-Brown et al 2018), the first evidence-based (Lumba-Brown et al 2018;Covassin et al 2013;Kontos et al 2012;Merritt and Arnett 2014;Merritt et al 2015;Lau et al 2011) guidelines for treatment of concussion for U.S. children. The present study analyzed reported student-athlete concussion data from three consecutive school years (2015)(2016)(2017)(2018), as reported by a certified athletic trainers (ATCs) and school nurses, employed full time, at public secondary or HS throughout New Jersey (NJ) to an online surveillance system (Shendell et al 2018;Shendell et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Incidence reporting via online high school concussion surveillance by certified athletic trainers and school nurses, 2015–2018

et al. 2020

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Background: There is an increasing concern over adolescent concussions in sports due to risks of long-term negative effects. This study analyzed data over three school years on reported concussion incidence rates by season, high school grade levels and gender, and reported symptoms by school nurses versus athletic trainers, from New Jersey student-athlete concussion data available from an online school-based surveillance system. Methods: School nurses and athletic trainers reported 300 concussions within five days from when each occurred over three school years, 2015-2018, in team sports and physical education in New Jersey high schools. Analysis was further conducted on symptoms and number of symptoms reported by school nurses versus school athletic trainers for each documented student-athlete concussion. Estimated concussion incidence rates were calculated using state agency verified school enrollment data. Findings: Concussions most commonly occurred during fall, followed by spring, then winter. Concussion incidence rates ranged from 6.3/1000 (4.99, 7.55) -9.1/1000 (7.27, 10.98) students over the three school years of the study. Athletic trainers completed 86% of the reports while nurses completed 11% (position or title of 3%, or n = 7, were not disclosed); the values were similar when considering only fall pre-season and regular season sports (88, 10, 2%, respectively). On average, across the three school years, athletic trainers reported about 3.5 symptoms per report while nurses reported 2.7 (values in fall seasons only were 3.7 and 3.1, respectively.) Conclusions: Certified athletic trainers, compared to school nurses, more often completed concussion report forms and reported more symptoms per injured student, perhaps due partly to closer contact and immediate care provided after injury. Additionally, this study had a higher concussion incidence rate during fall sports seasons compared to winter and spring. Future research can further improve our understanding of concussions among adolescent student-athletes to better inform concussion identification, management and recovery protocols.

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Section: Introductionmentioning

confidence: 99%

Incidence reporting via online high school concussion surveillance by certified athletic trainers and school nurses, 2015–2018

et al. 2020

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“…To ensure compliance, participants received daily e-mail or text reminders to access the online symptom questionnaire-the Sport Concussion Assessment Tool 3 Post-Concussion Symptom Scale (PCSS). 12 The PCSS is a validated 22-item questionnaire scored on a 7-point Likert scale (0-6), for a maximum possible score of 132. Symptoms on the PCSS can be separated into the following categories: physical, cognitive, sleep, and affective.…”

Section: Study Proceduresmentioning

confidence: 99%

“…Symptoms on the PCSS can be separated into the following categories: physical, cognitive, sleep, and affective. 12 If, for any reason, a participant was unable to provide a daily symptom report for 3 days in a row, he or she was withdrawn from the study. Daily symptom reports are critical to determining recovery.…”

Section: Study Proceduresmentioning

confidence: 99%

Postexercise Slowing on the King-Devick Test and Longer Recovery From Sport-Related Concussion in Adolescents: A Validation Study

Haider

Worts

Viera

et al. 2020

Journal of Athletic Training

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Context The King-Devick (KD) test is a rapid number-reading test that has emerging use in the assessment of sport-related concussion (SRC). Previous research suggested that healthy individuals and patients with acute concussions who had shorter recovery times (<3 weeks) demonstrated a learning effect on the KD test after mild to moderate exertion, whereas patients with longer recovery times did not. Objective To assess if the absence of postexertional improvement on the KD test within 10 days of concussive head injury was associated with a longer duration of recovery. Design Prospective cohort study. Setting University concussion-management clinics. Patients or Other Participants Male and female adolescent athletes (n = 99, aged 13–18 years) presenting within 10 days of SRC. Main Outcome Measure(s) The KD test was administered before and after the Buffalo Concussion Treadmill Test (BCTT). Days from injury to recovery, with recovery defined as being asymptomatic, confirmed by the assessment of a physician who was blinded to the treatment group, and the return of normal exercise tolerance on the BCTT were recorded. Results Participants with postexertional slowing (PES group, n = 33) had a longer duration of recovery (17 days versus 13.5 days, P = .033) than participants without PES (no-PES group, n = 66). At any clinic visit, PES was also associated with a relative risk of 2.36 (95% confidence interval = 1.55, 3.61; P < .001) of not recovering within the following week. Conclusions The current study validates our prior work showing that acutely concussed adolescents who did not display the typical learning effect on the KD test after the BCTT took longer to recover from SRC than those who exhibited the typical learning effect.

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“…Our outcome variables included whether the patient experienced persistent symptoms ( > 28 days), as well as vestibular symptom severity at the time of initial clinical evaluation, and performance on the modified Balance Error Scoring System (mBESS) at the time of initial clinical evaluation. In order to determine symptom status, participants completed the Post-Concussion Symptom Scale (PCSS) [29]. On this scale, patients were asked to identify the number and severity (from 0-6) of 22 different concussion symptoms.…”

Section: Outcome Variablesmentioning

confidence: 99%

Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

et al. 2020

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Our purpose was to evaluate the effect of self-reported pre-injury anxiety diagnosis on persistent symptom development, vestibular symptom severity, and balance control among youth who sustained a concussion. We performed a retrospective study of patients seen at a specialty pediatric concussion clinic. Patients were 18 years of age or younger, examined within 10 days of concussion, and received care until full recovery. A questionnaire was used to assess pre-existing medical and psychiatric conditions, including anxiety. Our main outcomes were prolonged symptom recovery defined as persistent symptoms for > 28 days after concussion) and severity of vestibular symptoms. Patients who reported pre-injury anxiety (n=43; median age=14.9 years; 37% female) were more likely to experience symptoms>28 days post-injury (76 vs. 54%; p=0.04) than those without pre-existing anxiety (n=241; median age=14.9 years; 53% female). After adjusting for sex, history of migraine, depression and ADHD, however, there was no independent association between pre-existing anxiety and prolonged symptom duration (adjusted odds ratio=2.34; 95% CI=0.083–6.63; p=0.11). Pre-existing anxiety was independently associated with self-reported nausea/vomiting severity (β coefficient=0.59, 95% CI=0.07–1.11). A pre-existing anxiety diagnosis does not appear to be associated with persistent symptoms after concussion, although it may be associated with post-injury nausea.

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A novel approach to classifying postconcussion symptoms: The application of a new framework to the Post-Concussion Symptom Scale

Abstract: These findings suggest that, in addition to evaluating the postconcussion total symptom score, there may be value in examining more specific symptom indices such as the global indices of distress variables and symptom clusters.

Cited by 41 publications

References 35 publications

Incidence reporting via online high school concussion surveillance by certified athletic trainers and school nurses, 2015–2018

Incidence reporting via online high school concussion surveillance by certified athletic trainers and school nurses, 2015–2018

Postexercise Slowing on the King-Devick Test and Longer Recovery From Sport-Related Concussion in Adolescents: A Validation Study

Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

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