Postconcussive impairment differences across a multifaceted concussion assessment protocol

PM R. 2011 Oct;3(10 Suppl 2):S445-51. doi: 10.1016/j.pmrj.2011.08.009.


Objective: To examine the proportion of athletes with concussion and with impairment disagreements across various clinical concussion assessment measures.

Design: Quasi-experimental repeated measures design.

Setting: Clinical research laboratory.

Participants: A sample of 100 collegiate-aged athletes participated in the study (mean [SD] age, 18.5 ± 1.1 years; mean [SD] height, 180.6 ± 9.9 cm; mean [SD] weight, 84.1 ± 20.6 kg). METHODS OR INTERVENTIONS: Participants completed preseason baseline and postconcussive injury assessments on a clinical assessment battery, including a 17-item graded symptom checklist, a computerized neurocognitive assessment, and a balance performance assessment.

Main outcome measurements: Symptom severity total score, 8 cognitive domain scores from the Automated Neuropsychological Assessment Metrics, and the composite balance score obtained from the Sensory Organization Test served as outcome measures for the study. McNemar tests of paired proportions were then used to analyze impairment disagreements (where one measure identified impairments not identified by the other) between the study outcome measures. The α level was set to .05 a priori.

Results: We observed significant disagreements between symptom severity total scores, and all other measures used in the study in which symptom severity total scores identified more impairments than all other measures. In addition, we observed significant disagreements for half of the clinical measures used in the study, with disagreement proportions that ranged from 22%-52%.

Conclusions: Our study underscores the importance of using a multifaceted approach for management of concussion that includes assessment of symptom severity, cognitive function, and balance. Use of this multifaceted approach also can aid clinicians in understanding other comorbidities that may complicate the management of concussion.

MeSH terms

  • Adolescent
  • Athletes
  • Athletic Injuries / physiopathology
  • Cognition / physiology
  • Dizziness / physiopathology
  • Female
  • Humans
  • Male
  • Neck Pain / physiopathology
  • Neurologic Examination
  • Neuropsychological Tests*
  • Post-Concussion Syndrome / physiopathology*
  • Postural Balance / physiology
  • Severity of Illness Index
  • Sleep Stages / physiology