Factor Structure for the Sport Concussion Assessment Tool Symptom Scale in Adolescents After Concussion

Abstract

Objective:To examine the factor structure of the Sport Concussion Assessment Tool-5 (SCAT5) symptom scale in adolescents on their initial presentation to a concussion clinic within the typical recovery period after concussion (ie, <30 days). We hypothesize that the SCAT5 symptoms represent various clinically meaningful groups. A secondary purpose was to examine the effects of sex on the factor structure of the SCAT5 symptom scale.Study Design:Retrospective cross-sectional analysis.Setting:Tertiary, institutional.Patients:Nine hundred eighty-one adolescents (45% women) aged between 13 and 18 years.Independent Variables:Adolescents completed the SCAT5 symptom scale.Main Outcome Measures:The factor structure of SCAT5 examined using a principal axis factor analysis.Results:A 5-factor structure model explained 61% of the variance in symptoms. These 5 factors are identified as Energy (17%), Mental Health (13%), Migrainous (13%), Cognitive (9%), and Vestibulo-Ocular (9%). A similar 5-factor model emerged for each sex, and the proportion of variance in symptoms explained by the 5-factor model was comparable between the sexes.Conclusions:The findings of this report indicate that the SCAT5 symptoms aggregated into 5 delineated factors, and these factors were largely consistent across the sexes. The delineation of symptoms into 5 factors provides preliminary validation for the presence of different concussion phenotypes. Confirmatory factor analysis is warranted to examine the applicability and clinical utility of the use of the 5-factor structure in a clinical setting.

Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion

“… 64 , 67 , 103 This is further seen through the factor analysis of SCAT5 symptoms, in which individuals with higher symptom scores related to the Mental Health domain are associated with a longer time between injury and assessment. 3 While 1 in 3 individuals will eventually seek treatment for their mental health condition, 95 , 98 the initial evaluation is often delayed from the initial onset of symptoms. On average, individuals with a mood disorder will delay treatment for 8 years, while those with an anxiety disorder will delay for 9 years.…”

“…Factor weightings were extracted from studies that performed exploratory factor analysis on SCAT symptom scores 3 , 5 or reported symptom domain groupings. 8 , 61 These factor weightings were used to calculate factor scores for all participants, 44 following the 3-factor (Migraine Fatigue, Affective, Cognitive-Ocular), 5 4-factor (Physical/Somatic, Insomnia/Sleep, Emotional, Cognitive), 8 , 61 and 5-factor (Energy, Mental Health, Migrainous, Cognitive, Vestibulo-ocular) 3 schemes. Using SPSS 27.0, we ran 2-way analyses of variance for each factor, investigating whether the factor scores were significantly different between mental health conditions, and between the control and condition subgroups.…”

“…We did not observe any statistically significant differences in factor scores between the mental health conditions for any of the factor schemes. 3,5,8,61 In contrast, Asken et al 8 found that individuals with psychiatric disorders (depression and anxiety) had higher scores in the Emotional domain. These differences may be because of the different study populations since Asken et al 8 studied nonconcussed individuals while the current study evaluated individuals who were being assessed for concussion.…”

“…Evaluating different domains of concussion-related symptoms may give insight into the effects of preexisting mental health conditions on symptomatology. 3 , 5 , 8 , 61 One study found that the symptom domain of mental health contributes to the variance of concussion-related symptomatology. 3 Another study determined that ADHD is associated with reporting 1 or more cognitive symptoms, whereas anxiety and depression are associated with reporting 1 or more emotional symptoms.…”

“… 3 , 5 , 8 , 61 One study found that the symptom domain of mental health contributes to the variance of concussion-related symptomatology. 3 Another study determined that ADHD is associated with reporting 1 or more cognitive symptoms, whereas anxiety and depression are associated with reporting 1 or more emotional symptoms. 8 Additional research is required to investigate these symptom domains in concussed individuals with mental health conditions.…”