High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes

Abstract

Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined.Context: To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC.Objective: Cohort study.Design: High school and collegiate athletic programs.Setting: A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68).Patients or Other Participants: Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment.Main Outcome Measure(s): The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group.Results: Reported baseline symptoms may help identify athletes at risk for worse outcomes after SRC. Clinicians should examine baseline symptom levels to better identify patients for earlier referral and treatment for their injury. Additional investigation of baseline symptoms is warranted to help delineate the type and severity of premorbid symptoms.Conclusions:

Prospective Changes in Vestibular and Ocular Motor Impairment After Concussion

“…28 Similarly, an increase in post-concussion symptom reports are well documented in the literature during the first week following SRC and may persist for several weeks. 8,27 The documentation of pre- to post-injury changes in vestibular and oculomotor symptoms and impairment supports the VOMS as a part of the recommended multifaceted approach for SRC assessment.…”

“…1–3 Concussion consensus statements encourage the use of assessments that measure multiple domains, including symptom reports, neurocognitive function, and balance performance, in conjunction with a detailed clinical exam and interview. 3–6 Many SRC assessments such as cognitive testing 7 and symptom reports 8 are best administered in a prospective method (i.e., baseline/pretest, posttest) that allows for each concussed athlete to serve as their own non-injured control. 7,9,10 This approach allows for the comparison of post-injury data to baseline data.…”

Postural Stability in Healthy Child and Youth Athletes: The Effect of Age, Sex, and Concussion-Related Factors on Performance

“…22 How child and youth athletes feel in the present moment can provide important contextual information that may assist in the interpretation of postconcussion comparisons of postural stability scores. 7,17,25 For example, a large sample of healthy/uninjured child and adolescent athletes displayed a wide range of concussion-like symptoms. 17 However, how these baseline symptoms affect baseline postural stability is not known.…”

Medico‐Legal Aspects of Concussion

“…Over‐diagnosing of cognitive impairment post‐concussion can occur when preexisting factors are not considered. Previous medical diagnoses of headaches, 62,63 migraines, 64 Attention‐Deficit Hyperactivity Disorder (ADHD), 65‐67 learning disability, 68 and psychiatric conditions 69‐72 may influence symptom presentation and these conditions are known to contribute to a high baseline symptom score pre‐concussion and worsened symptom score and neuropsychological test performance post‐concussion 73,74 . Moreover, sleep difficulties, pain, and side effects of medication (eg, topiramate for migraine prevention) can influence performance on neurocognitive outcome measures and confound findings 75 .…”