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Original Investigation |

Factors Associated With Concussion-like Symptom Reporting in High School Athletes

Grant L. Iverson, PhD1,2,3,4; Noah D. Silverberg, PhD5; Rebekah Mannix, MD, MPH6; Bruce A. Maxwell, PhD7; Joseph E. Atkins, PhD8; Ross Zafonte, DO1,3,4; Paul D. Berkner, DO9
[+] Author Affiliations
1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
2Spaulding Rehabilitation Hospital, Boston, Massachusetts
3MassGeneral Hospital for Children Sports Concussion Program, Boston
4Red Sox Foundation and Massachusetts General Hospital Home Base Program Boston
5Division of Physical Medicine and Rehabilitation, University of British Columbia, and GF Strong Rehab Centre, Vancouver, British Columbia, Canada
6Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
7Department of Computer Science, Colby College, Waterville, Maine
8Department of Psychology, Colby College, Waterville, Maine
9Health Services and Department of Biology, Colby College, Waterville, Maine
JAMA Pediatr. 2015;169(12):1132-1140. doi:10.1001/jamapediatrics.2015.2374.
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Importance  Every state in the United States has passed legislation for sport-related concussion, making this health issue important for physicians and other health care professionals. Safely returning athletes to sport after concussion relies on accurately determining when their symptoms resolve.

Objective  To evaluate baseline concussion-like symptom reporting in uninjured adolescent student athletes.

Design, Setting, and Participants  In this cross-sectional, observational study, we studied 31 958 high school athletes from Maine with no concussion in the past 6 months who completed a preseason baseline testing program between 2009 and 2013.

Results  Symptom reporting was more common in girls than boys. Most students with preexisting conditions reported one or more symptoms (60%-82% of boys and 73%-97% of girls). Nineteen percent of boys and 28% of girls reported having a symptom burden resembling an International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS). Students with preexisting conditions were even more likely to endorse a symptom burden that resembled PCS (21%-47% for boys and 33%-72% for girls). Prior treatment of a psychiatric condition was the strongest independent predictor for symptom reporting in boys, followed by a history of migraines. For girls, the strongest independent predictors were prior treatment of a psychiatric condition or substance abuse and attention-deficit/hyperactivity disorder. The weakest independent predictor of symptoms for both sexes was history of prior concussions.

Conclusions and Relevance  In the absence of a recent concussion, symptom reporting is related to sex and preexisting conditions. Consideration of sex and preexisting health conditions can help prevent misinterpretation of symptoms in student athletes who sustain a concussion.

Figures in this Article


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Rates of International Classification of Diseases, 10th Revision (ICD-10), Postconcussional Syndrome Classification in High School Athletes With No Recent Concussion (Mild or Greater Symptoms in Each Domain)

No athlete in this study reported sustaining a concussion in the past 6 months. ADHD indicates attention-deficit/hyperactivity disorder; LD, learning disability.

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