Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents

Abstract

Psychometric characteristics of the Postconcussion Symptom Inventory (PCSI) were examined in both concussed (n = 633) and uninjured (n = 1,273) 5 to 18 year olds. Parent- and self-report forms were created with developmentally appropriate wording and content. Factor analyses identified physical, cognitive, emotional, and sleep factors; that did not load strongly or discriminate between groups were eliminated. Internal consistency was strong for the total scales (α = 0.8-0.9). Test-retest reliability for the self-report forms was moderate to strong (intraclass coeffecients, ICCs = 0.65-0.89). Parent and self-report concordance was moderate (r = .44-.65), underscoring the importance of both perspectives. Convergent validity with another symptom measure was good (r = .8). Classification analyses indicated greater discriminability from parent report, but caveats to this are presented. With strong psychometric characteristics, the four versions of the PCSI capture important postconcussion symptoms and can be utilized to track recovery from pediatric concussion and guide treatment recommendations.

Concussion-Like Symptoms in Child and Youth Athletes at Baseline: What Is “Typical”?

“…Our findings are similar to those of Sady et al 11 in older youths but less than those in younger children (24%). Although we noted similar percentages of headaches across the sexes, results from a recent metaanalysis 17 suggest that females (ages 12À26 years) were more likely than males to report baseline symptoms of headache.…”

“…Approximately 20% of our older group rated fatigue as a moderate problem (ie, score of at least 3 on the PCSI). Results from another large cohort study 11 of children and youth at baseline indicated that fatigue was also the most often reported symptom, albeit to a lesser extent (younger children ¼ 45% and older youth ¼ 35%). We speculate that this may reflect the unique characteristics of our sample: namely elite athletes, who, especially at older ages, spent 3 to 7 days per week participating in their sport in addition to fulfilling academic demands.…”

“…Self-report measures created specifically for the child and youth population were designed to offer a developmentally sensitive approach to concussion assessment. 3,11 Cognitive skills, reading levels, vocabulary, sense of time, familiarity with symptom language, and social-emotional maturity are developmental factors that vary in children and youths and may affect how they respond to symptom-reporting scales. 3,11 The Post-Concussion Symptom Inventory (PCSI), 3,11 a self-report concussion-symptoms measure with strong psychometric properties, 11 was created to address these developmental factors.…”

“…Specific versions of the PCSI are available for age groups that span 5 to 18 years. Authors of a psychometric study 11 of the PCSI provided data on a normative sample of healthy children and youths, but this sample was not athlete specific. In healthy youths ages 13 to 18 years, the most commonly reported symptoms at baseline were fatigue (35%), difficulty falling asleep (27%), drowsiness (26%), headache (24%), nervousness (24%), and difficulty concentrating (23%).…”

Academic Effects of Concussion in Children and Adolescents

“…10 Participants within each recovery group were further stratified based on level of schooling (grades K through 5 for elementary school, 6 through 8 for middle school, and 9 through 12 for high school) to examine hypothesized grade level differences. Study hypotheses were examined by using x 2 statistics to examine group differences in the type and frequency of academic problems, trouble with classes, levels of concern, and grade status/ change.…”