Factors associated with post-concussion syndrome in high school student-athletes

J Sci Med Sport. 2018 May;21(5):447-452. doi: 10.1016/j.jsams.2017.08.025. Epub 2017 Sep 14.


Objectives: To identify factors associated with post-concussion syndrome (PCS) among a national sample of high school student-athletes from the 2011/12-2013/14 academic years.

Design: Ambispective cohort study from sports injury surveillance data.

Methods: Sport-related concussion data originated from the National Athletic Treatment, Injury and Outcomes Network (NATION) surveillance program, consisting of 27 sports from a convenience sample of 196 high schools across 26 states. All SRCs were reported by certified athletic trainers. The PCS and non-PCS groups consisted of concussed individuals with symptoms resolution time of >4 weeks and ≤2 weeks, respectively. Logistic regression estimated the association of athlete and concussion characteristics on the odds of PCS, and calculated adjusted odds ratios (OR) and 95% confidence intervals (CI).

Results: Overall, 1334 concussed high school athletes met inclusion criteria: 215 in the PCS group and 1119 in the non-PCS group. In the multivariable analysis, concussion symptoms associated with increased odds of PCS included: retrograde amnesia (OR=3.01, 95%CI: 1.31-6.91), difficulty concentrating (OR=2.72, 95%CI: 1.56-4.77), disorientation (OR=1.86; 95%CI: 1.04-3.33), insomnia (OR=2.79; 95%CI: 1.62-4.80), loss of balance (OR=1.76; 95%CI: 1.00-3.10), sensitivity to noise (OR=1.80; 95%CI: 1.02-3.17), and visual disturbance (OR=2.21; 95%CI: 1.23-3.97). Sex and recurrent concussion were not associated with PCS.

Conclusions: As in previous research, somatic and cognitive symptoms were associated with PCS. The identification of factors associated with PCS may assist clinicians in identifying concussed athletes at greater risk of having longer symptom resolution time.

Keywords: Adolescent; Brain injuries; Epidemiology; Sports.

MeSH terms

  • Adolescent
  • Athletes / statistics & numerical data*
  • Athletic Injuries / epidemiology*
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Neuropsychological Tests
  • Odds Ratio
  • Population Surveillance
  • Post-Concussion Syndrome / diagnosis*
  • Post-Concussion Syndrome / epidemiology*
  • Risk Factors