Dispositional, situational factors can mimic ICD-10 criteria for postconcussion syndrome
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Published results showed preexisting conditions, insufficient sleep or stress can mimic the ICD-10 symptom criteria for postconcussion syndrome among individuals with no recent concussion.
Jaclyn B. Caccese, PhD, and colleagues assessed the Sport Concussion Assessment Tool—3rd Edition symptom evaluation and Demographics and Personal Family Medical History unique case report form completed by 12,039 U.S. Service Academy cadets and 18,548 NCAA student athletes at baseline preseason testing. Researchers used the ICD-10 symptom criteria for postconcussion syndrome diagnostic categorization.
Results showed subgroups of cadets and student athletes who did not recently experience a concussion reported a cluster of symptoms that would meet the ICD-10 symptom criteria for postconcussion syndrome. Researchers found significant predictors of meeting the ICD-10 symptom criteria for postconcussion syndrome for male and female cadets included being a cadet at the U.S. Coast Guard Academy and at the U.S. Air Force Academy, being a freshman cadet, insufficient sleep the night before the baseline assessment, having a psychiatric disorder and academic problems. Migraine history was also a significant predictor among male cadets, according to results.
Among male and female student athletes, researchers noted insufficient sleep the night before the baseline assessment, having a psychiatric disorder, sleep disorder, depression and ADHD were significant independent predictors of meeting the ICD-10 symptom criteria for postconcussion syndrome. Additional significant independent predictors included concussion history among male student athletes and migraine history among female student athletes, results showed.
“Many people experience symptoms throughout life that are consistent with symptoms experienced by individuals following concussion, and dispositional and situational factors (eg, sleep) can influence symptom reporting,” Caccese told Healio Orthopedics. “Thus, when clinicians interpret symptoms following concussion, particularly in individuals with prolonged symptoms, they must consider both injury-related factors, as well as other factors not necessarily associated with the injury (eg, mental health history). Concussion management needs to be on a person-specific basis, and it is possible that athletes may not be totally asymptomatic following concussion if they reported one or more concussion-like symptoms before their injury.”
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Our understanding of concussions and their consequences has increased in recent years. Typically, in order for an individual to return to activity, the nonspecific symptoms must resolve after a period of cognitive rest and graduated recovery. Persistence of symptomatology can occur and is termed postconcussive syndrome. The rate in which these symptoms meet the criteria for postconcussive syndrome among healthy patients is unknown, which may lead to misdiagnosis in the event the patient sustains a concussion. The authors must be commended for their study investigating the rates of postconcussive syndrome symptomology in a large cohort of cadets and student athletes who have not sustained a concussion.
This study found a large portion of healthy cadets and athletes reported symptoms meeting the diagnostic criteria for postconcussive syndrome. Moreover, insufficient sleep, preexisting conditions and freshman cadets were associated with an increased likelihood of meeting symptom criteria for postconcussive syndrome. It should be noted that the authors did not remark on the severity of the symptomology among healthy patients (eg, fatigue, nausea), which could noticeably worsen after a concussion. Overall, this study illustrates that accurate concussion assessment must occur in a patient-by-patient fashion, necessitating symptom assessment before and after concussion to account for preexisting symptomology.
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