A novel approach to classifying postconcussion symptoms: The application of a new framework to the Post-Concussion Symptom Scale

Abstract

Introduction: Self-report measures such as the Post-Concussion Symptom Scale (PCSS) are frequently used during baseline and postconcussion testing to evaluate athletes’ symptom profiles. However, the common approach of evaluating the total symptom score and/or symptom clusters may not allow for a complete understanding of the nature of athletes’ symptom reporting patterns. The primary objective of this study was to apply three “global indices of distress” variables, derived from the Symptom Checklist-90-Revised (SCL-90-R) framework, to the PCSS at baseline and postconcussion. We aimed to evaluate the utility of these symptom indices in relation to four PCSS symptom clusters and the total PCSS symptom score. Method: Participants included college athletes evaluated at baseline (N = 846) and postconcussion (N = 86). Athletes underwent neuropsychological testing at both time points, including completion of the PCSS and a paper/pencil and computerized test battery. Eight symptom indices were derived from the PCSS, and a postconcussion neurocognitive composite score was calculated. Results: Results showed that there were significant mean increases from baseline to postconcussion on four of the eight symptom indices evaluated. Furthermore, a significant proportion of athletes showed no change from baseline to postconcussion when evaluating the total symptom score, but showed at least a one standard deviation increase in symptom reporting from baseline to postconcussion when evaluating at least one other symptom index (i.e., a global index of distress or symptom cluster). Finally, the three global indices of distress variables, two of the four symptom clusters, and the total symptom score significantly predicted a postconcussion neurocognitive composite score, such that greater postconcussion symptoms were associated with lower postconcussion neurocognitive performance. Conclusions: These findings suggest that, in addition to evaluating the postconcussion total symptom score, there may be value in examining more specific symptom indices such as the global indices of distress variables and symptom clusters.

Keywords:

• Sports-related concussion
• Postconcussion symptoms
• Collegiate athletes

The authors would also like to thank Gray Vargas, Amanda Rabinowitz, Fiona Barwick, Aaron Rosenbaum, and Chris Bailey for their help as project coordinators over the years. Finally, we would like to acknowledge the following individuals for their help with running participants and data entry for this project: Karissa Arthur, Dan Brynien, Saima Farooq, Caitlin Gaffney, Alex Garrison, Briana Hauser, Mark Petusky, Matt Phillips, Jordyn Sessel, Julie Turco, and Steven Yacovelli.

Additional information

Funding

The authors have no conflicts of interest to report. No formal grant funding was obtained for this project; however, we would like to thank Penn State Sports Medicine and Wayne Sebastianelli for their ongoing support of our concussion program.