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On-Field Signs Predict Future Acute Symptoms After Sport-Related Concussion: A Structural Equation Modeling Study

Published online by Cambridge University Press:  08 January 2018

Benjamin L. Brett ,
Andrew W. Kuhn ,
Aaron M. Yengo-Kahn ,
Aaron S. Jeckell ,
Gary S. Solomon  and
Scott L. Zuckerman
Benjamin L. Brett*
Affiliation:
Department of Psychology, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut Department of Counseling, Educational Psychology and Research, The University of Memphis, Memphis, Tennessee Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee
Andrew W. Kuhn
Affiliation:
Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee
Aaron M. Yengo-Kahn
Affiliation:
Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
Aaron S. Jeckell
Affiliation:
Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
Gary S. Solomon
Affiliation:
Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
Scott L. Zuckerman
Affiliation:
Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
*
Correspondence and reprint requests to: Benjamin Brett, Department of Psychology, Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516. E-mail: blbrett@memphis.edu
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Abstract

Objectives: This study investigated the relationship between on-field, objective signs immediately following sport-related concussion and self-reported symptom endorsement within 1 day post injury. Methods: A retrospective case series of 237 concussed high school athletes was performed. On-field signs were evaluated immediately post injury. Self-reported symptoms (2 clusters) were collected within 1 day post injury. A two-step structural equation model and follow-up bivariate regression analyses of significant on-field signs and symptom clusters were performed. Results: Signs of immediate memory, β=0.20, p=.04, and postural instability, β=0.19, p < .01, significantly predicted a greater likelihood of endorsing the cognitive-migraine-fatigue symptom cluster within 1 day post injury. Regarding signs correlated with specific symptoms, immediate memory was associated with symptoms of trouble remembering, χ 2 =37.92, p < .001, odds ratio (OR)=3.89 (95% confidence interval (CI) [2.47, 6.13]), and concentration difficulties, χ 2 =10.84, p=.001, OR=2.13 (95% CI [1.37, 3.30]). Postural instability was associated with symptom endorsement of trouble remembering, χ 2 =12.08, p < .001, OR=1.76 (95% CI [1.29, 2.40]). Conclusions: Certain post-concussion on-field signs exhibited after injury were associated with specific symptom endorsement within 1 day post injury. Based on these associations, individualized education-based interventions and academic accommodations may help reduce unanticipated worry from parents, students, and teachers following a student-athlete’s sport-related concussion, especially in cases of delayed onset symptoms. (JINS, 2018, 24, 476–485)

Keywords

Mild traumatic brain injurySport-related concussionTraumaSports medicineSymptomsStructural equation modelingHead injuries
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 24 , Issue 5 , May 2018 , pp. 476 - 485
Copyright
Copyright © The International Neuropsychological Society 2018 

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