Sports Medicine Research: In the Lab & In the Field: Athletes With High Baseline Concussion Symptom Scores May Need Special Considerations (Sports Med Res)
Friday, May 20, 2016

Athletes With High Baseline Concussion Symptom Scores May Need Special Considerations

High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes

Custer A, Sufrinko A, Elbin RC, Covassin T, Collins M, and Kontos A. Journal of Athletic Training: February 2016, 51 (2): 136-141.

Take Home Message: Athletes who report numerous concussion symptoms during baseline testing may experience greater neurocognitive impairment after a concussion than athletes who do not report baseline symptoms.

Commonly, athletes complete baseline concussion assessments, which are used for comparison after an injury.  While these baseline measurements are meant to evaluate a healthy athlete, some athletes report symptoms at baseline. It is unclear if baseline symptoms relate to outcomes after a concussion. Custer et al. examined if athletes with numerous baseline symptoms had worse neurocognitive outcomes after a concussion than athletes without baseline symptoms. The authors evaluated 670 high school and collegiate athletes at baseline and 2 to 7 days after a concussion with the Immediate Post-concussion Assessment and Cognitive Test and Postconcussion Symptom Scale (PCSS). Within this sample, the authors identified two groups: 1) No baseline symptoms (PCSS score = 0, 247 athletes) and 2) High-level baseline symptoms (PCSS score > 18, 68 athletes). They then compared the PCSS scores and the Immediate Post-Concussion Assessment and Cognitive Test composite score; which included verbal memory, visual memory, visual motor processing speed, and reaction time; between the two groups. The authors found that athletes with baseline symptoms experience more neurocognitive impairments after a concussion in verbal (~11% decline from baseline) and visual memory tests (~15% decline) compared with athletes without baseline symptoms (6% and 9% decline, respectively). Custer et al. also found that athletes who reported baseline symptoms did not report a change in total PCSS scores from pre-injury to post-injury (< 1 point), while athletes with no baseline symptoms reported an increase in PCSS scores from pre-injury to post-injury (on average ~20 point increase).

This research explores an area that is often overlooked by clinicians and is under-reported in the literature. Baseline tests are considered a valuable tool to compare an athlete’s status before and after injury, but there are limitations and non-ideal situations that should be considered. Symptom evaluations are a subjective measure so it is not surprising that different athletes report symptoms differently. A clinician should consider why an athlete has baseline symptoms and consider repeating the baseline evaluation when the athlete has no symptoms. However, if baseline symptoms are the result of underlying conditions, such as medical history or personality, this study shows that special considerations should be made while making a clinical decision. For example, if an athlete with a high baseline PCSS score does not show a change in total symptom score between pre- and post- injury evaluations a clinician should look at the change in individual symptoms, as well as other measures to make a diagnosis. Additionally, this research suggests that clinicians may be able to educate athletes, parents, coaches, etc. that athletes with no baseline symptoms may have subtle changes in memory after a head injury. Therefore, clinicians must recognize the limitations of the PCSS while evaluating athletes with high baseline scores and understand that these athletes may be at a high risk for acute cognitive impairment after injury.

Questions for Discussion: How much attention do you pay to baseline symptom scores? How do you deal with abnormal baseline results while making a clinical decision post-injury?

Written by: Joshua Baracks
Reviewed by: Jeffrey Driban

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Custer A, Sufrinko A, Elbin RJ, Covassin T, Collins M, & Kontos A (2016). High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes. Journal of athletic training, 51 (2), 136-41 PMID: 26885702

3 comments:

Psych Nairo said...

The baseline symptoms should be taken seriously to prevent the devastating effects of traumatic brain injuries. Let us take better care of our athletes. Thanks for the post.

Alexandra DeJong said...

I certainly agree that clinicians should put an emphasis on baseline concussion testing in order to ensure that the measurements being taken throughout an athletes career can be adequately evaluated. However, in the context of this study, I think it is also extremely important to think about other extraneous factors that may play a role in the severity of future concussions. I would be interested to know the root of what was causing the deviations in baseline score, such as if they were related to migraines, illness, or other issues. This would be an important area for future research, but this article certainly sets the tone for further studies in this area.

Joshua Baracks said...

Alexandra,

Thanks for adding your opinion and yes I agree with you that more research is needed on the topic. Brain injuries are complex and we are just at the tip of the iceberg in terms of our understanding of the injury.

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