Archives of Clinical Neuropsychology Advance Access published online on June 23, 2009
Archives of Clinical Neuropsychology, doi:10.1093/arclin/acp025
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Concussion Symptom Inventory: an empirically derived scale for monitoring resolution of symptoms following sport-related concussion
a Department of Neurology, Loyola University Medical Center, Chicago (Maywood), IL, USA
b Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
c Department of Neurology, New York University School of Medicine, New York, NY, USA
d Department of Psychiatry, New York University School of Medicine, New York, NY, USA
e Neuroscience Center, Waukesha Memorial Hospital, Waukesha, WI, USA
f Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
g Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
h Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
i Department of Neurosurgery, University of Colorado Denver School of Medicine, Denver, CO, USA
j Department of Physical Medicine and Rehabilitation, University of Colorado Denver School of Medicine, Denver, CO, USA
* Corresponding author at: 1 East Erie, Suite 355, Chicago, IL 60611, USA. Tel.: +1-708-216-3539; fax: +1-708-216-4629. E-mail address: crandol{at}lumc.edu (C. Randolph).
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Abstract |
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Self-report post-concussion symptom scales have been a key method for monitoring recovery from sport-related concussion, to assist in medical management, and return-to-play decision-making. To date, however, item selection and scaling metrics for these instruments have been based solely upon clinical judgment, and no one scale has been identified as the "gold standard". We analyzed a large set of data from existing scales obtained from three separate case–control studies in order to derive a sensitive and efficient scale for this application by eliminating items that were found to be insensitive to concussion. Baseline data from symptom checklists including a total of 27 symptom variables were collected from a total of 16,350 high school and college athletes. Follow-up data were obtained from 641 athletes who subsequently incurred a concussion. Symptom checklists were administered at baseline (preseason), immediately post-concussion, post-game, and at 1, 3, and 5 days post-injury. Effect-size analyses resulted in the retention of only 12 of the 27 variables. Receiver-operating characteristic analyses were used to confirm that the reduction in items did not reduce sensitivity or specificity. The newly derived Concussion Symptom Inventory is presented and recommended as a research and clinical tool for monitoring recovery from sport-related concussion.
Keywords Brain injury; Post-concussion; Scale
Accepted: May 27, 2009