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

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

Grant L Iverson  1 , Noah D Silverberg  2 , Rebekah Mannix  3 , Bruce A Maxwell  4 , Joseph E Atkins  5 , Ross Zafonte  6 , Paul D Berkner  7
Affiliations
Observational Study

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

Grant L Iverson et al. JAMA Pediatr. 2015 Dec.

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Iverson reported being reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild traumatic brain injury and sport-related concussion at meetings, scientific conferences, and symposiums. He reported having a clinical practice in forensic neuropsychology that involves individuals who have sustained mild traumatic brain injuries (including athletes). He reported receiving honorariums for serving on research panels that provide scientific peer review of programs. He is a coinvestigator, collaborator, or consultant on grants relating to mild traumatic brain injury funded by several organizations. He reported receiving research support from test publishing companies in the past, including ImPACT Applications Systems (not in the past 5 years). No other disclosures were reported.

Figures

Figure
Figure. Rates of International Classification of Diseases, 10th Revision (ICD-10), Postconcussional Syndrome Classification in High School Athletes With No Recent Concussion (Mild or Greater Symptoms in Each Domain)
No athlete in this study reported sustaining a concussion in the past 6 months. ADHD indicates attention-deficit/hyperactivity disorder; LD, learning disability.
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