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Uninjured athletes present with concussion-like symptoms, obscure concussion diagnostics
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A significant proportion of uninjured high school athletes presented with symptoms related to post-concussion syndrome, making symptom-based diagnosis of concussions difficult for clinicians, according to recent research in JAMA Pediatrics.
“The purpose of this study is to clarify factors associated with concussion-like symptoms in uninjured adolescents using a unique data set of more than 30,000 adolescent student athletes,”
Grant L. Iverson, PhD, director of the neuropsychology outcome assessment laboratory at the department of physical medicine and rehabilitation at Harvard Medical School, and colleagues wrote. “We found that most students report concussion-like symptoms, with symptom reporting greater in girls and those with a pre-existing condition.”
The researchers studied a cohort of 31,958 high school athletes from Maine, aged 13 to 18 years, between 2009 and 2013. To evaluate baseline symptoms among high school athletes, all participants were concussion-free during the 6 months before enrollment. The students completed a health history survey, including details related to attention-deficit/hyperactivity disorder, learning disabilities, headaches, migraines, epilepsy, brain surgery, meningitis, substance use and psychiatric conditions. The researchers also administered The Post-Concussion Scale to participants, requiring them to identify their discomfort on a scale of 0 to 6 for 22 symptoms. ICD-10 criteria were used to define the participants with post-concussion syndrome-like symptoms.
Study results showed that 28% of girls and 19% of boys were identified as having symptoms triggering a diagnosis of post-concussion syndrome.
The researchers found that athletes with pre-existing conditions were more likely to be classified with a diagnosis of post-concussion syndrome. Among boys, psychiatric conditions (47.4%) and migraines (34%) were the strongest correlating conditions; while substance abuse (72%), psychiatric conditions (55.3%) and ADHD (52.6%) were the strongest among girls.
The researchers noted that the weakest correlating condition for post-concussion syndrome, among boys (20.7%) and girls (33.3%), was prior history of one concussion.
“When managing a student-athlete with a concussion, it has been widely noted that the athlete should be ‘asymptomatic’ at rest and with exercise before returning to sports, and sometimes athletes are kept out of school for prolonged periods while they wait for symptoms to resolve, which could have negative consequences for their academic, social, and emotional functioning and contribute to symptom reporting.” Iverson and colleagues wrote. “These results reinforce that ‘asymptomatic’ status after concussion can be difficult to define.” – by David Costill
Disclosure: Iverson reports reimbursement from the government, professional scientific bodies, and commercial organizations, and receiving honorariums for serving on research panels that provide scientific peer review of programs.
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