Concussion Symptoms Predictive of Adolescent Sport-Related Concussion Injury

Abstract

Objective: To assess the predictive capability of the postconcussion symptom scale (PCSS) of the sport concussion assessment tool (SCAT) III to differentiate concussed and nonconcussed adolescents. Design: Retrospective. Setting: Tertiary. Participants: Sixty-nine concussed (15.2 ± 1.6 years old) and 55 control (14.4 ± 1.7 years old) adolescents. Independent Variables: Postconcussion symptom scale. Main Outcome Measure: Two-proportion z-test determined differences in symptom endorsement between groups. To assess the predictive power of the PCSS, we trained an ensemble classifier composed of a forest of 1000 decision trees to classify subjects as concussed, or not concussed, based on PCSS responses. The initial classifier was trained on all 22-concussion symptoms addressed in the PCSS, whereas the second classifier removed concussion symptoms that were not statistically significant between groups. Results: Concussion symptoms common between groups were trouble falling asleep, more emotional, irritability, sadness, and anxious. After removal, analysis of the second classifier indicated that the 5 leading feature rankings of symptoms were headache, head pressure, light sensitivity, noise sensitivity, and “don't feel right,” which accounted for 52% of the variance between groups. Conclusions: Collectively, self-reported symptoms through the PCSS can differentiate concussed and nonconcussed adolescents. However, predictability for adolescent patients may be improved by removing emotional and sleep domain symptoms.

Putative Concussion Biomarkers Identified in Adolescent Male Athletes Using Targeted Plasma Proteomics

“…Finally, concussions are diagnosed by clinical criteria, but clinical diagnostics tools are imperfect. The SCAT is the most widely used tool, and it is reported to have good diagnostic accuracy ( 10 ), but certain self-reported symptoms are unhelpful with initial concussion diagnosis in adolescents ( 10 , 11 ).…”

“…Accurate concussion diagnosis is critical for adolescents, as they are particularly susceptible to concussions ( 3 ) and to their potentially long-lasting neurological effects ( 8 , 9 ). While self-reported headache, head pressure, fatigue, and/or noise and light sensitivity have been identified as useful discriminators of injury, they are imperfect ( 10 , 11 ). A number of blood protein and lipid biomarkers for concussion diagnoses have also been investigated ( 4 , 12 – 15 ); however, current concussion guidelines do not recommend the use of any blood biomarkers for diagnosis in adolescents due to insufficient evidence ( 4 , 16 ), illustrating the need for additional biomarker exploratory studies.…”

Cognitive profiles following sport-related concussion in high school athletes.

“…ImPACT also includes a 22-item PCSS (Lovell et al, 2006). Items are rated on a seven-point Likert scale with 0 indicating “not experiencing this symptom,” 1 indicating “barely noticeable,” and 6 indicating “worst I have ever experienced.” The PCSS has demonstrated adequate reliability and good predictive utility in measuring postconcussion symptoms (Gioia et al, 2009; Harriss et al, 2020; Karr & Iverson, 2020; Merritt et al, 2018). An alternative four-factor structure has been proposed and confirmed for postconcussion symptom measurement consisting of cognitive complaints, sleep/arousal disturbances, physical symptoms, and affective symptoms factors (Karr & Iverson, 2020).…”

Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children

“…62 66 Symptom scales showed increased total symptoms and increased symptom severity in concussed athletes in the subacute assessment period (3-30 days postinjury) compared with baseline and healthy controls. 19 24 67 68 Specific symptoms such as dizziness, light sensitivity and feeling slowed down were more severe in concussed athletes than controls. 65 The most commonly used symptom scale was the PCSS, 4 while the Child SCAT incorporated the Health and Behaviour Inventory.…”