Assessing Symptoms in Adolescents Following Sport-Related Concussion: A Comparison of Four Different Approaches

Abstract

This study compared post-concussion symptom endorsements on the Post-Concussion Symptom Scale (PCSS) between a clinical open-ended interview, clinician-guided PCSS, parent-report PCSS, and computer-based PCSS in youth athletes with sport-related concussion (SRC). Participants included 54 patients aged 13-17 years (M = 15.19, SD = 1.29, 51.8% male) with a diagnosed SRC seen at a concussion clinic. Participants were administered a computer-based version (COMP) of the PCSS followed by clinical open-ended symptom interview (OPEN) and clinician-guided PCSS (GUIDED). Participants' parents concurrently and independently endorsed their children's symptoms by completing the PCSS in the waiting room (PARENT). Total number of symptoms reported and total symptom severity score were analyzed and compared across the four PCSS administration methods. Results revealed significantly lower total number of symptoms for OPEN compared to GUIDED (p = .002), PARENT (p < .001), and COMP (p = .006); and significantly lower total severity score for OPEN compared to GUIDED (p = .04) and PARENT (p < .001). These data support using the PCSS as a structured method of assessing post-concussion symptoms and question the utility of unstructured interview methods for assessing symptoms in youth athletes with SRC.

Parents’ and Child’s Concussion History as Predictors of Parental Attitudes and Knowledge of Concussion Recognition and Response

“…Parents have been found to both underestimate and overestimate the amount of pain that their child was in for a variety of diagnoses. 19,23,26 The current literature suggests that parents and athletes have difficulty identifying concussion symptoms within themselves, and parents may underestimate the number of symptoms that their child is experiencing, 4 while children do not feel that symptoms are a reason to stop participation when they are not severe or burdensome. 3 Parental knowledge encompassed the ability to identify signs and symptoms of a concussion as well as distractors that are not actually signs/symptoms or consequences of a concussion.…”

Concussion and the autonomic nervous system: An introduction to the field and the results of a systematic review

“…The actual prevalence of concussions is likely much higher than this figure, as only about a third of patients with concussion present for acute treatment in emergency departments; some present to primary care or urgent care clinics, and many do not seek any medical intervention ( Feigin et al, 2013 ; Sosin, Sniezek, & Thurman, 1996 ). A number of symptoms are associated with concussive injuries including headache, nausea, balance difficulties, light and noise sensitivity, cognitive difficulties, sleep disruption, and emotional disturbance ( de Guise et al, 2010 ; Elbin et al, 2016 ; Landre, Poppe, Davis, Schmaus, & Hobbs, 2006 ; Oldenburg, Lundin, Edman, Nygren-de Boussard, & Bartfai, 2016 ).…”

“…The Valsalva maneuver can be used to evaluate the responsiveness of sympathetic and parasympathetic baroreflex pathways to changes in intrathoracic pressure ( Low, Tomalia, & Park, 2013 ; Novak, 2011 ). Participants blow into a mouthpiece connected to a pressure monitor and are instructed to maintain a pre-determined pressure for 15 seconds.…”

“…Head upright tilt table testing provides an evaluation of the blood pressure and heart rate response to tilt and is used to detect orthostatic hypotension (failure of the baroreflex to maintain stable cerebral blood pressure in response to postural stasis and positional change) ( Low et al, 2013 ; Novak, 2011 ). Alternative, indirect methods to measure baroreflex impairment to postural challenge include tracking for symptoms of syncope (fainting) and pre-syncopal symptoms (such as visual symptoms or lightheadedness when standing).…”

Anxiety and mood clinical profile following sport-related concussion: From risk factors to treatment.

“…Higher levels of parental preinjury anxiety and child-reported stress at six months after concussion are predictive of a greater burden of postconcussive symptoms at 18 months postinjury (Olsson et al, 2013). Moreover, there is research showing increased symptom reporting by parents for their concussed child, as compared with the child’s self-report (Elbin et al, 2016). The mechanism by which family dynamics may influence recovery from SRC is unclear, though one possible pathway may be through reporting style (i.e., tendency to over or underreport), as athletes may be pushed toward one direction as a result of situational factors.…”