A cross-sectional cohort study of post-concussive symptoms and their relationships with depressive symptoms in youth with and without concussion

Reference values for the adolescent post version of the Postconcussion Symptom Inventory from the German general population

The present study aims at providing reference values from the general pediatric population for the German version of the 21-item self-report post version of the Postconcussion Symptom Inventory for adolescents aged 13-17 years (PCSI-SR13) following pediatric traumatic brain injury (pTBI). A total of N = 950 adolescents completed an adapted version of the PCSI-SR13. Prior to establishing reference values using percentiles, psychometric properties (i.e., reliability and factorial validity) and regression analyses were examined to identify factors contributing to PCSI-SR13 scores. In addition, construct assessment in the general population sample was compared to that in the pTBI sample (N = 234) using measurement invariance analyses and direct comparisons at the score levels. The results indicate good reliability (Cronbach's α and McDonald's ω of 0.97 each). The four-factor structure covering physical, emotional, cognitive, and fatigue symptom groups could be replicated with χ2(183) = 995.96, p < 0.001, χ2/df = 5.44, CFI = 0.99, TLI = 0.98, RMSEA (90% CI) = 0.068 (0.064, 0.073), SRMR = 0.03. With minor restrictions, the assessment of symptoms was comparable between the general population and the pTBI samples. Participants in the pTBI sample reported a significantly higher symptom burden than those in the general population sample. Reference values were provided using the total sample without further stratification. Conclusion: For the German post version of the PCSI-SR13, reference values are now available for direct score comparisons and for drawing conclusions about the clinical relevance of the reported symptoms, while considering the prevalence in a comparable general population without a history of pTBI.Trial registration: The study is retrospectively registered in the German Clinical Trials Register and in the International Clinical Trials Registry Platform (ID DRKS00032854).

Characterizing the Network Structure of Post-Concussion Symptoms

OBJECTIVE

Assessment of post-concussion symptoms is implemented at secondary, post-secondary, and professional levels of athletics. Network theory suggests that disorders can be viewed as a set of interacting symptoms that amplify, reinforce, and maintain one another. Examining the network structure of post-concussion symptoms may provide new insights into symptom comorbidity and may inform targeted treatment. We used network analysis to examine the topology of post-concussion symptoms using the Post-Concussion Symptom Scale (PCSS) in high school athletes with recent suspected sport-related concussion.

METHOD

Using a cross-sectional design, the network was estimated from Post Concussion Symptom Scale scores from 3,292 high school athletes, where nodes represented symptoms and edges represented the association between symptoms. Node centrality was calculated to determine the relative importance of each symptom in the network.

RESULTS

The network consisted of edges within and across symptom domains. "Difficulty concentrating" and "dizziness" were the most central symptoms in the network. Although not highly central in the network, headaches were the highest rated symptom.

CONCLUSIONS

The interconnectedness among symptoms supports the notion that post-concussion symptoms are interrelated and mutually reinforcing. Given their central role in the network, "difficulty concentrating" and "dizziness" are expected to affect the activation and persistence of other post-concussion symptoms. Interventions targeting difficulties with concentration and dizziness may help alleviate other symptoms. Our findings could inform the development of targeted treatment with the aim of reducing overall symptom burden. Future research should examine the trajectory of post-concussion symptom networks to advance the clinical understanding of post-concussive recovery.

Improving subacute management of post concussion symptoms: a pilot study of the Melbourne Paediatric Concussion Scale parent report

Aim:

To pilot a modification of the Post Concussion Symptom Inventory, the Melbourne Paediatric Concussion Scale (MPCS) and examine its clinical utility.

Materials & methods:

A total of 40 families of concussed children, aged 8–18 years, were recruited from the emergency department. Parent responses to the MPCS in the emergency department and 2-weeks post injury determined child symptomatic status. Association between MPCS symptom endorsement and symptomatic group status was examined.

Results:

All additional MPCS items were endorsed by at least 25% of the parents of symptomatic children at 2 weeks. MPCS items were classified into nine symptom domains, with most falling in mood, neurological, autonomic and vestibular domains.

Conclusion:

The additional items and domain classifications in the MPCS have the potential to improve subacute diagnostic precision, monitoring of clinical recovery and identification of appropriate interventions post pediatric concussion.