Factors Associated With Concussion-like Symptom Reporting in High School Athletes

JAMA Pediatr. 2015 Dec;169(12):1132-40. doi: 10.1001/jamapediatrics.2015.2374.


Importance: Every state in the United States has passed legislation for sport-related concussion, making this health issue important for physicians and other health care professionals. Safely returning athletes to sport after concussion relies on accurately determining when their symptoms resolve.

Objective: To evaluate baseline concussion-like symptom reporting in uninjured adolescent student athletes.

Design, setting, and participants: In this cross-sectional, observational study, we studied 31 958 high school athletes from Maine with no concussion in the past 6 months who completed a preseason baseline testing program between 2009 and 2013.

Results: Symptom reporting was more common in girls than boys. Most students with preexisting conditions reported one or more symptoms (60%-82% of boys and 73%-97% of girls). Nineteen percent of boys and 28% of girls reported having a symptom burden resembling an International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS). Students with preexisting conditions were even more likely to endorse a symptom burden that resembled PCS (21%-47% for boys and 33%-72% for girls). Prior treatment of a psychiatric condition was the strongest independent predictor for symptom reporting in boys, followed by a history of migraines. For girls, the strongest independent predictors were prior treatment of a psychiatric condition or substance abuse and attention-deficit/hyperactivity disorder. The weakest independent predictor of symptoms for both sexes was history of prior concussions.

Conclusions and relevance: In the absence of a recent concussion, symptom reporting is related to sex and preexisting conditions. Consideration of sex and preexisting health conditions can help prevent misinterpretation of symptoms in student athletes who sustain a concussion.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Athletes
  • Athletic Injuries / epidemiology*
  • Brain Concussion / diagnosis
  • Brain Concussion / epidemiology*
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • International Classification of Diseases
  • Logistic Models
  • Male
  • Neuropsychological Tests
  • Post-Concussion Syndrome / diagnosis
  • Post-Concussion Syndrome / epidemiology*
  • Risk Factors
  • Schools
  • Students
  • United States