Concussion Clinical Profiles Screening (CP Screen) Tool: Preliminary Evidence to Inform a Multidisciplinary Approach

Abstract

BACKGROUND Current concussion symptom inventories emphasize total number or symptoms and severity and overlap with other conditions, such as mental health disorders, which may limit their specificity and clinical utility. OBJECTIVE To develop and test the reliability and validity of a new Concussion Clinical Profiles Screening tool (CP Screen) in both healthy controls and concussed. METHODS CP Screen is a 29-item self-report, clinical profile-based symptom inventory that measures the following 5 concussion clinical profiles: 1) anxiety/mood, 2) cognitive/fatigue, 3) migraine, 4) ocular, and 5) vestibular; and the following 2 modifying factors: 1) sleep and 2) neck. Post-Concussion Symptom Scale (PCSS), vestibular/ocular motor screening (VOMS) tool, and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) were conducted. CP Screen was administered in community a concussion surveillance program and 2 sports medicine concussion clinics. Responses include 248 athletes, 121 concussed, and 127 controls, enrolled between 2018 and 2019. RESULTS Internal consistency of the CP Screen in the control (Cronbach's alpha = .87) and concussed (Cronbach's alpha = .93) samples was high. Moderate to high correlations among the CP Screen factors and PCSS factors and VOMS items, supporting concurrent validity. ROC curve analysis for identifying concussed from controls was significant (P < .001) for all CP Screen factor and modifier scores with excellent AUCs for migraine (.93), ocular (.88), vestibular (.85), and cognitive (.81) factors, demonstrating predictive validity. CONCLUSION The CP Screen demonstrated strong reliability, concurrent validity with commonly used concussion assessment (ie, PCSS, VOMS, and ImPACT), and predictive validity for identifying concussion. The CP Screen extends current symptom inventories by evaluating more specific symptoms that may reflect clinical profiles and inform better clinical care.

The Emerging Role of Telehealth for Concussion Clinical Care During the Coronavirus (COVID-19) Pandemic

“…This initiative produced a comprehensive list of recommended assessments and summaries of empirical support. These CDEs may overlap or supplement emerging inventories (eg, Clinical Profiles Screen: CP Screen4) that together can help identify specific concussion impairments or even clinical profiles (eg, anxiety/mood, cognitive, headache/migraine, ocular, vestibular) 2,4…”

Developing Insights for Possible and Probable Acute Concussions Using Cluster Analysis

“…These results aligns with the findings by Kontos et al, who found that, compared with all symptom groups in this study, the post-traumatic migraine symptom group could most accurately discriminate between concussed athletes and controls whereas the anxiety-mood symptom group was the worst performing. 26 In our analysis, the ocular-vestibular group played a small role whereas the cognitive-fatigue symptom group appeared to be the most important after the post-traumatic migraine symptom group. In contrast, they found that ocular and vestibular symptom groups had the second and third highest discriminative ability, respectively, among all symptom groups.…”

“…These symptom groups have shown strong reliability and validity for concussion screening. 25,26 We obtained the score for each symptom group by adding the severity scores of the symptoms within each group. We included the raw score for each symptom group along with the total number of symptoms reported.…”

Machine Learning for Subtyping Concussion Using a Clustering Approach

“…Historically, concussion classification approaches have grouped subtypes according to particular symptoms or a combination of affected systems. From the concussion profiles suggested by Collins et al ( 2014 ) to the most recent subtypes as proposed by Lumba-Brown et al ( 2020 ) and Kontos et al ( 2020 ), the approach to subtyping has been grounded in heuristics derived from clinical experience and patient presentation or reporting.…”