Neurocognitive test performance and symptom reporting in cheerleaders with concussions

J Pediatr. 2013 Oct;163(4):1192-5.e1. doi: 10.1016/j.jpeds.2013.05.061. Epub 2013 Aug 12.


Objective: To evaluate neurocognitive test results and symptom reporting after sports-related concussion in a group of female cheerleaders.

Study design: Junior and senior high school female cheerleaders (n = 138) underwent preparticipation baseline testing and repeated the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) evaluation within 7 days of concussive injury (range, 0-7 days; mean, 3.9 days). Postinjury neurocognitive and symptom scores were compared with preinjury (baseline) scores. "Abnormal" test performance was determined statistically using Reliable Change Index scores and self-reported symptoms. Main outcome variables included the composite scores indices from the ImPACT test, as well as symptoms reported by participants. Preinjury baseline and postinjury test results were compared using MANOVA.

Results: As a group, cheerleaders with concussion evaluated within 7 days of injury performed poorly on the ImPACT test battery relative to their own baseline (F = 6.5; P = .00). In addition, 61% of the cheerleaders with concussions reported an increase in symptoms compared with baseline. The groups did not differ significantly by position on the squad (F = 0.37; P = .96). Of the group of cheerleaders who did not report increased symptoms at the time of postinjury evaluation, 37% had at least 1 abnormal ImPACT composite score result, suggesting some residual cognitive decline compared with baseline.

Conclusion: The diagnosis and management of concussion in cheerleaders should not consist solely of self-reported symptoms. Neurocognitive test results represent an important component of the evaluation process and may identify athletes with residual neurocognitive deficits who report being clinically asymptomatic.

Keywords: ED; Emergency department; ImPACT; Immediate Postconcussion Assessment and Cognitive Testing; PCS; Postconcussion Symptoms; RCI; Reliable Change Index.

MeSH terms

  • Adolescent
  • Athletes
  • Athletic Injuries / diagnosis*
  • Athletic Injuries / physiopathology
  • Brain Concussion / diagnosis*
  • Brain Concussion / physiopathology
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / etiology
  • Cognition Disorders / physiopathology
  • Female
  • Humans
  • Neuropsychological Tests*
  • Schools
  • Sports*
  • Surveys and Questionnaires
  • Treatment Outcome