On‐field signs of concussion predict deficits in cognitive functioning: Loss of consciousness, amnesia, and vacant look

Influence of Personal and Injury-Related Factors Predicting Deficits in Quality of Life Domains Among Pediatric Athletes: Findings From the Sport Concussion Outcomes in Pediatrics Study

OBJECTIVE

To examine patient and injury factors that may predict quality of life (QoL) and symptom duration after concussion.

DESIGN

Prospective, longitudinal.

SETTINGS

Six children's hospital-based medical centers and 9 secondary school athletic training facilities.

PATIENTS

Pediatric patients (8-18 years) were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit for a diagnosis of sport-related concussion.

INTERVENTIONS

Patients completed a medical history, the Postconcussion Symptom Inventory (PCSI), and Patient-Reported Outcomes Measurement Information System Pediatric Profile-25 (PROMIS-PP).

MAIN OUTCOME MEASURES

Eight predictor variables [age, sex, assessment time, loss of consciousness, amnesia and history of concussion, migraines, or attention-deficit hyperactivity disorder or (ADHD)] were assessed using regression models constructed for each dependent variable.

RESULTS

A total of 244 patients (15.1 ± 2.1 years, 41% female) were enrolled (mean = 5 ± 3 days after concussion; range = 1-14 days). Female sex, later initial assessment, and presence of amnesia were associated with lower QoL scores on several domains, whereas loss of consciousness was associated with higher QoL for fatigue. A history of migraines was associated with lower peer relationship QoL. Patients who subsequently developed persisting symptoms had lower mobility scores and higher anxiety, depressive symptom, fatigue, and pain interference scores.

CONCLUSIONS

Female sex, later clinic presentation, and amnesia were associated with a lower QoL related to mobility, anxiety, depressive symptoms, fatigue, and pain interference. Interestingly, previous concussion and preinjury ADHD diagnosis did not negatively impact postinjury QoL at the initial visit. Future studies should assess the influence of these factors on QoL at later postinjury time points using a concussion-specific outcomes instrument.

Post-Concussion Acute Signs and Reliable Cognitive Decline in a Finnish Youth Ice Hockey Sample

OBJECTIVE

In sports concussion research, the importance of an individualized approach incorporating neuropsychological assessment data has been emphasized. This study examined the impact of acute signs of concussion on post-injury cognitive functioning using reliable change methodology in a sample of Finnish, elite-level, youth ice hockey players.

METHODS

From a sample of 1,823 players (all male, 14-20 years old) who completed preseason baseline testing with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery, two subgroups were identified. First, in total, 312 uninjured athletes, who completed baseline testing twice-1 year apart. The scores were contrasted to calculate reliable change indices (RCIs). Second, from a subsample of 570 athletes participating in an intensive follow-up arm of the project, the analysis included 32 concussed athletes. The RCIs were determined for the five ImPACT composite scores and used in identifying athletes with declined performance 3 days post-injury.

RESULTS

Test-retest reliability ranged from .39 to .71. Athletes who had experienced an acute loss of consciousness, amnesia, or postural instability had increased odds for declines in two or more areas assessed by ImPACT (odds ratio = 7.67-8.00, p < .05). In contrast, acute disorientation or vacant look did not lead to cognitive change that met the reliable change threshold.

CONCLUSIONS

The reliability coefficients and RCIs differed from those published earlier emphasizing the importance of national reference values. The presence of acute loss of consciousness, amnesia, or postural instability may indicate a more severe injury and predict the need for more intensive cognitive follow-up.

Visible Signs of Concussion and Cognitive Screening in Community Sports

Video surveillance and detection of players with visible signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of visible signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared with players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (n = 22) and CoSign- (n = 61) groups were similar with respect to age, sex, education, baseline mood, and medical history. CoSign+ players exhibited worse orientation, concentration, and recall, and slower reaction time in attention and working memory tasks. Comparing individual change from baseline to post-match assessment revealed 100% (95% confidence interval [CI]: 84-100%) of CoSign+ players demonstrated clinically significant deficits on SCAT3 or Cogstate tasks, compared with 59% (95% CI: 46-71%) of CoSign- players. All CoSign+ players observed to have a blank/vacant look demonstrated clinically significant decline on the Standardized Assessment of Concussion (SAC). Detection of visible signs of concussion represents a rapid, real-time method for screening players suspected of concussion in community sports where video technology and medical personnel are rarely present. Consistent with community guidelines, it is recommended that all CoSign+ players be immediately removed from play for further concussion screening.