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
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

Related Posts:

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