Factors Associated with Symptom Reporting in U.S. Service Academy Cadets and NCAA Student Athletes without Concussion: Findings from the CARE Consortium

Caccese, Jaclyn B.; Iverson, Grant L.; Hunzinger, Katherine J.; Asken, Breton M; Clugston, James R.; Cameron, Kenneth L.; Houston, Megan N.; Svoboda, Steven J.; Jackson, Jonathan; McGinty, Gerald; Estevez, Carlos A.; Susmarski, Adam; Enrique, Alexander; Bryk, Kelsey; Broglio, Steven P.; McAllister, Thomas W.; McCrea, Michael; Pasquina, Paul F.; Buckley, Thomas A.

doi:10.1007/s40279-020-01415-4

Cited by 23 publications

(19 citation statements)

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“…21,26,[53][54][55] Furthermore, up to 25% of uninjured athletes and cadets reported baseline symptoms consistent with the International Statistical Classification of Diseases and Related Health Problems, 10th The American Journal of Sports Medicine Revision, criteria for the postconcussion syndrome. 5,11 Nonconcussed cadets have also reported neurological symptoms after intense bouts of exercise. 2 Thus, relying on symptom scores that may be unrelated to the concussion could delay the RTA progression and necessitates a need for further understanding of these symptom thresholds.…”

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confidence: 99%

Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets

et al. 2022

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Background: Current consensus and position statements recommend that concussed patients be asymptomatic upon the initiation of the graduated return to activity (RTA) protocol. However, a significant number of concussed patients are beginning their RTA protocols while endorsing symptoms. Purpose: To characterize symptom endorsement at the beginning of the RTA protocol and examine the association between symptom endorsement and RTA protocol duration in service academy cadets. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort study was conducted with cadets at 3 US service academies. Postconcussion symptom inventories were recorded upon the initiation of an RTA protocol. The Sport Concussion Assessment Tool Symptom Inventory was used to classify participants into 3 groups (0 symptoms, 1 symptom, and ≥2 symptoms) upon the initiation of the RTA protocol. The primary outcome of interest was RTA protocol duration. Kaplan-Meier survival estimates were calculated to estimate RTA protocol duration by symptom endorsement, sex, varsity status, academic break, and time to graduated RTA initiation. Univariate and multivariable Cox proportional hazards models were used to estimate the association between symptom endorsement at the initiation of the RTA protocol and RTA protocol duration (α < .05). Results: Data were analyzed from 966 concussed cadets (36% women). Headache (42%) and faintness/dizziness (44%) were the most commonly endorsed symptoms on the Sport Concussion Assessment Tool-Third Edition and the Brief Symptom Inventory-18, respectively. Univariate results revealed a significant association between endorsing ≥2 symptoms and RTA protocol duration. In the multivariable model, endorsing ≥2 symptoms maintained a statistically significant association with RTA protocol duration. Significant associations were observed between RTA protocol duration and nonvarsity status (27% longer), women (15% longer), academic breaks (70% longer), and time to the initiation of the RTA protocol (1.1% longer daily incremental increase) after controlling for covariates. Conclusion: Symptom endorsement at the initiation of an RTA protocol was associated with RTA protocol duration. Cadets who had returned to preinjury baseline symptom burden or improved from baseline symptom burden and endorsed ≥2 symptoms at the initiation of the RTA protocol took longer to RTA.

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Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets

et al. 2022

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“…Because symptoms, such as fatigue (31%-62% of collegiate student athletes and cadets endorse .1 on Likert 0-6 scale at baseline) and nervousness/anxiousness (13%-26%), are common in everyday life and have high base rates; they may not be specific to concussion. [3][4][5][6] Conversely, other symptoms, such as nausea/vomiting (2%-6%) and dizziness (3%-9%), have lower base rates and may be more specific to concussion. [3][4][5][6] In addition to establishing the sensitivity/specificity of individual symptom severity scores, we can use classification trees to identify the best combination of symptom(s) severity scores for concussion diagnosis from the Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom checklist.…”

Section: Introductionmentioning

confidence: 99%

“…3–6 Conversely, other symptoms, such as nausea/vomiting (2%-6%) and dizziness (3%-9%), have lower base rates and may be more specific to concussion. 3–6…”

Section: Introductionmentioning

confidence: 99%

“…3 Furthermore, 11% of men and 20% of women reported a cluster of symptoms that would meet the International Classification of Diseases, 10th Revision symptom criteria for postconcussion syndrome. 3 These data are similar to those reported among other independent cohorts and highlight the fact that some individuals report a high number of symptoms in the absence of recent concussion. [4][5][6] A central unresolved question is what individual symptom(s) and the associated severity scores are sensitive/specific for concussion diagnosis?…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Conversely, other symptoms, such as nausea/vomiting (2%-6%) and dizziness (3%-9%), have lower base rates and may be more specific to concussion. [3][4][5][6] In addition to establishing the sensitivity/specificity of individual symptom severity scores, we can use classification trees to identify the best combination of symptom(s) severity scores for concussion diagnosis from the Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom checklist. Broglio et al 1 used similar methods to identify the most efficient multifaceted assessment pathway to identify concussion.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Test–Retest Reliability and Efficacy of Individual Symptoms in Concussion Management

Caccese¹,

Garcia²,

Kontos³

et al. 2022

Clinical Journal of Sport Medicine

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Investigating the overlapping associations of prior concussion, default mode connectivity, and executive function-based symptoms

Brett

Bryant

España

et al. 2022

Brain Imaging and Behavior

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Factors Associated with Symptom Reporting in U.S. Service Academy Cadets and NCAA Student Athletes without Concussion: Findings from the CARE Consortium

Cited by 23 publications

References 24 publications

Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets

Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets

Test–Retest Reliability and Efficacy of Individual Symptoms in Concussion Management

Investigating the overlapping associations of prior concussion, default mode connectivity, and executive function-based symptoms

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