Representation of concussion subtypes in common postconcussion symptom-rating scales

Angela Lumba-Brown; Jamshid Ghajar; Jordan Cornwell; O Josh Bloom; James Chesnutt; James R Clugston; Raina Kolluri; John J Leddy; Masaru Teramoto; Gerard Gioia

doi:10.2217/cnc-2019-0005

Representation of concussion subtypes in common postconcussion symptom-rating scales

Concussion. 2019 Nov 1;4(3):CNC65. doi: 10.2217/cnc-2019-0005.

Authors

Affiliations

¹ Department of Emergency Medicine, Stanford University, Stanford, CA 94304, USA.
² Department of Neurosurgery, Brain Performance Center, Stanford University, Stanford, CA 94304 USA.
³ Carolina Sports Concussion Clinic, Cary, NC 27513, USA.
⁴ Departments of Family Medicine, Neurology, Oregon Health & Science University, Portland, OR & Rebound Orthopedics & Neurosurgery, Portland, OR 97239, USA.
⁵ Departments of Community Health & Family Medicine & Neurology, University of Florida, Gainesville, FL 32611, USA.
⁶ Department of Neurosurgery, Brain Performance Center, Stanford University, Stanford, CA 94304, USA.
⁷ UBMD Department of Orthopaedics & Sports Medicine, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14203, USA.
⁸ Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT 84108, USA.
⁹ Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery & Education Program, Children's National Health System, Departments of Pediatrics & Psychiatry & Behavioral Sciences, George Washington University School of Medicine, Rockville, MD 20850, USA.

Abstract

Aim: Postconcussion symptom-rating scales are frequently used concussion assessment tools that do not align directly with new expert, consensus-based concussion subtype classification systems. This may result in delays in concussion diagnosis, subspecialty referral and rehabilitative strategies.

Objective: To determine the representation of subtype-directed symptomatology in common postconcussion symptom-rating scales.

Methods: Literature review and expert consensus were used to compile commonly used concussion symptom-rating scales. Statistics were generated to describe the degree of representation of the consensus symptom set.

Results: The percentage of symptoms representing each subtype/associated condition is low overall (15-26%). The ocular-motor (11%) and vestibular subtypes (19%) and cervical strain (5%)-associated condition were the most under-represented and also had the greatest unmet needs.

Conclusion: Concussion subtypes do not have equal representation on commonly used concussion symptom-rating scales. There is a need for a subtype-directed symptom assessment to allow for increased accuracy of diagnosis and to guide management.

Keywords: concussion; oculomotor; postconcussion symptoms; vestibular.

Publication types

Review