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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*
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

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)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2018 

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References

REFERENCES

Anderson, J.C., & Garbing, D.W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411423.Google Scholar
Belanger, H.G., & Vanderploeg, R.D. (2005). The neuropsychological impact of sports-related concussion: A meta-analysis. Journal of the International Neuropsychological Society, 11(4), 345357.CrossRefGoogle ScholarPubMed
Bonfield, C.M., Lam, S., Lin, Y., & Greene, S. (2013). The impact of attention deficit hyperactivity disorder on recovery from mild traumatic brain injury. Journal of Neurosurgery. Pediatrics, 12(2), 97102. doi: 10.3171/2013.5.PEDS12424 CrossRefGoogle ScholarPubMed
Broglio, S.P., Cantu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., & Palm, M., National Athletic Trainer’s Association. (2014). National Athletic Trainers’ Association position statement: Management of sport concussion. Journal of Athletic Training, 49(2), 245265. doi: 10.4085/1062-6050-49.1.07 Google Scholar
Broglio, S.P., Sosnoff, J.J., & Ferrara, M.S. (2009). The relationship of athlete-reported concussion symptoms and objective measures of neurocognitive function and postural control. Clinical Journal of Sport Medicine, 19(5), 377382. doi: 10.1097/JSM.0b013e3181b625fe Google Scholar
Byrne, B. (1994). Structural equation modeling with EQS and EQS/Windows. Thousand Oaks, CA: Sage.Google Scholar
Cantu, R.C. (2001). Posttraumatic retrograde and anterograde amnesia: Pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36(3), 244248.Google ScholarPubMed
Collins, M.W., Iverson, G.L., Lovell, M.R., McKeag, D.B., Norwig, J., & Maroon, J. (2003). On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clinical Journal of Sport Medicine, 13(4), 222229.Google Scholar
Coronado, V.G., McGuire, L.C., Faul, M., Sugerman, D.E., & Pearson, W.S. (2012). Traumaticbrain injury epidemiology and public health issues. In D.I. Zasler, D.E. Katz & R.D. Zafonte (Eds.), Brain injury medicine: Principles and practice (pp. 84100). New York, NY: Demos Medical Publishing.Google Scholar
Duhaime, A.C., Beckwith, J.G., Maerlender, A.C., McAllister, T.W., Crisco, J.J., Duma, S.M., & Greenwald, R.M. (2012). Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: Clinical article. Journal of Neurosurgery, 117(6), 10921099. doi: 10.3171/2012.8.JNS112298 Google Scholar
Echemendia, R.J., Iverson, G.L., McCrea, M., Broshek, D.K., Gioia, G.A., Sautter, S.W., & Barr, W.B. (2012). Role of neuropsychologists in the evaluation and management of sport-related concussion: An inter-organization position statement. Archives of Clinical Neuropsychology, 27(1), 119122. doi: 10.1093/arclin/acr077 Google Scholar
Ellis, M.J., Cordingley, D.M., Vis, S., Reimer, K.M., Leiter, J., & Russell, K. (2017). Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion. Journal of Neurosurgery. Pediatrics, 19(1), 3845. doi: 10.3171/2016.7.PEDS16310 Google Scholar
Fleishman, J., & Benson, J. (1987). Using LISREL to evaluate measurement models and scale reliability. Educational and Psychological Measurement, 47(4), 925.Google Scholar
Ganesalingam, K., Yeates, K.O., Ginn, M.S., Taylor, H.G., Dietrich, A., Nuss, K., & Wright, M. (2008). Family burden and parental distress following mild traumatic brain injury in children and its relationship to post-concussive symptoms. Journal of Pediatric Psychology, 33(6), 621629. doi: 10.1093/jpepsy/jsm133 CrossRefGoogle ScholarPubMed
Gessel, L., Fields, S., Collins, C., Dick, R., & Comstock, R. (2007). Concussions among United States high school and collegiate athletes. Journal of Athletic Training, 42(4), 495503.Google Scholar
Gioia, G.A. (2016). Medical-school partnership in guiding return to school following mild traumatic brain injury in youth. Journal of Child Neurology, 31(1), 93108. doi: 10.1177/0883073814555604 CrossRefGoogle ScholarPubMed
Giza, C.C., & Hovda, D.A. (2014). The new neurometabolic cascade of concussion. Neurosurgery, 75(Suppl 4), S24S33. doi: 10.1227/NEU.0000000000000505 CrossRefGoogle ScholarPubMed
Graham, R., Rivara, F., Ford, M., & Mason Spicer, C. (2014). Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: National Academies Press.Google Scholar
Guskiewicz, K.M., Bruce, S.L., Cantu, R.C., Ferrara, M.S., Kelly, J.P., McCrea, M., & Valovich McLeod, T.C. (2004). National Athletic Trainers’ Association Position Statement: Management of sport-related concussion. Journal of Athletic Training, 39(3), 280297.Google Scholar
Guskiewicz, K.M., Ross, S.E., & Marshall, S.W. (2001). Postural stability and neuropsychological deficits after concussion in collegiate athletes. Journal of Athletic Training, 36(3), 263273.Google Scholar
Hair, J., Anderson, R., Tatham, R., & Black, W. (1998). Multivariate data analysis (5th ed.), London: Prentice Hall International.Google Scholar
Halstead, M.E., & Walter, K.D., Council on Sports Medicine and Fitness. (2010). American Academy of Pediatrics. Clinical report--Sport-related concussion in children and adolescents. Pediatrics, 126(3), 597615. doi: 10.1542/peds.2010-2005 Google Scholar
Harmon, K.G., Drezner, J.A., Gammons, M., Guskiewicz, K.M., Halstead, M., Herring, S.A., & Roberts, W.O. (2013). American Medical Society for Sports Medicine position statement: Concussion in sport. British Journal of Sports Medicine, 47(1), 1526. doi: 10.1136/bjsports-2012-091941 CrossRefGoogle ScholarPubMed
Howell, D.R., Osternig, L.R., & Chou, L.S. (2015). Return to activity after concussion affects dual-task gait balance control recovery. Medicine and Science in Sports and Exercise, 47(4), 673680. doi: 10.1249/MSS.0000000000000462 CrossRefGoogle ScholarPubMed
Hu, L.T., & Bentler, P.M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 155.Google Scholar
Hunt, T.N., Ferrara, M.S., Bornstein, R.A., & Baumgartner, T.A. (2009). The reliability of the modified Balance Error Scoring System. The Clinical Journal of Sports Medicine, 19, 471475.Google Scholar
Iverson, G.L., Atkins, J.E., Zafonte, R., & Berkner, P.D. (2016). Concussion history in adolescent athletes with attention-deficit hyperactivity disorder. Journal of Neurotrauma, 33(23), 20772080. doi: 10.1089/neu.2014.3424 CrossRefGoogle ScholarPubMed
Iverson, G.L., Silverberg, N.D., Mannix, R., Maxwell, B.A., Atkins, J.E., Zafonte, R., & Berkner, P.D. (2015). Factors associated with concussion-like symptom reporting in high school athletes. JAMA Pediatrics, 169(12), 11321140. doi: 10.1001/jamapediatrics.2015.2374 Google Scholar
Karr, J.E., Areshenkoff, C.N., & Garcia-Barrera, M.A. (2014). The neuropsychological outcomes of concussion: A symptomatic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology, 28, 321336.Google Scholar
Keightley, M.L., Saluja, R.S., Chen, J.K., Gagnon, I., Leonard, G., Petrides, M., & Ptito, A. (2014). A functional magnetic resonance imaging study of working memory in youth after sports-related concussion: Is it still working? Journal of Neurotrauma, 31(5), 437451. doi: 10.1089/neu.2013.3052 Google Scholar
Kontos, A.P., Elbin, R.J., Lau, B., Simensky, S., Freund, B., French, J., & Collins, M.W. (2013). Posttraumatic migraine as a predictor of recovery and cognitive impairment after sport-related concussion. The American Journal of Sports Medicine, 41(7), 14971504. doi: 10.1177/0363546513488751 CrossRefGoogle ScholarPubMed
Kontos, A.P., Elbin, R.J., Schatz, P., Covassin, T., Henry, L., Pardini, J., & Collins, M.W. (2012). A revised factor structure for the post-concussion symptom scale: Baseline and postconcussion factors. The American Journal of Sports Medicine, 40(10), 23752384. doi: 10.1177/0363546512455400 Google Scholar
Kuhn, A., Zuckerman, S., Yengo-Kahn, A., Kerr, Z.Y., Totten, D.J., Rubel, K.E., & Solomon, G.S. (2017). Factors associated with playing through a concussion. Neurosurgery, 64(Suppl 1), 211216.Google Scholar
Lee, H., Sullivan, S.J., & Schneiders, A.G. (2013). The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 16(1), 27. doi: 10.1016/j.jsams.2012.03.013 Google Scholar
McCrea, M., Guskiewicz, K.M., Marshall, S.W., Barr, W., Randolph, C., Cantu, R.C., & Kelly, J.P. (2003). Acute effects and recovery time following concussion in collegiate football players: The NCAA Concussion Study. JAMA, 290(19), 25562563. doi: 10.1001/jama.290.19.2556 Google Scholar
McCrea, M., Kelly, J.P., Kluge, J., Ackley, B., & Randolph, C. (1997). Standardized assessment of concussion in football players. Neurology, 48(3), 586588.Google Scholar
McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., & Vos, P.E. (2017). Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. doi: 10.1136/bjsports-2017-097699 Google Scholar
McCrory, P., Meeuwisse, W.H., Aubry, M., Cantu, B., Dvorák, J., Echemendia, R.J., & Turner, M. (2013). Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47(5), 250258. doi: 10.1136/bjsports-2013-092313 Google Scholar
Mucha, A., Collins, M.W., Elbin, R.J., Furman, J.M., Troutman-Enseki, C., DeWolf, R.M., & Kontos, A.P. (2014). A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: Preliminary findings. The American Journal of Sports Medicine, 42(10), 24792486. doi: 10.1177/0363546514543775 Google Scholar
Parker, T.M., Osternig, L.R., Lee, H.J., Donkelaar, P., & Chou, L.S. (2005). The effect of divided attention on gait stability following concussion. Clinical Biomechanics (Bristol, Avon), 20(4), 389395. doi: 10.1016/j.clinbiomech.2004.12.004 Google Scholar
Pearce, K.L., Sufrinko, A., Lau, B.C., Henry, L., Collins, M.W., & Kontos, A.P. (2015). Near point of convergence after a sport-related concussion: Measurement reliability and relationship to neurocognitive impairment and symptoms. The American Journal of Sports Medicine, 43(12), 30553061. doi: 10.1177/0363546515606430 Google Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Ayton, G., Nelms, R., & Ng, K. (2001). Impact of early intervention on outcome after mild traumatic brain injury in children. Pediatrics, 108(6), 12971303.Google Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A.M., Nelms, R., & Curran, C. (2002). Impact of early intervention on outcome following mild head injury in adults. Journal of Neurology, Neurosurgery, and Psychiatry, 73(3), 330332.CrossRefGoogle ScholarPubMed
Ransom, D.M., Vaughan, C.G., Pratson, L., Sady, M.D., McGill, C.A., & Gioia, G.A. (2015). Academic effects of concussion in children and adolescents. Pediatrics, 135(6), 10431050. doi: 10.1542/peds.2014-3434 Google Scholar
Reilly, D.S., van Donkelaar, P., Saavedra, S., & Woollacott, M.H. (2008). Interaction between the development of postural control and the executive function of attention. Journal of Motor Behavior, 40(2), 90102. doi: 10.3200/JMBR.40.2.90-102 Google Scholar
Squire, L.R., & Zola-Morgan, S. (1991). The medial temporal lobe memory system. Science, 253(5026), 13801386.Google Scholar
Tator, C.H., Davis, H.S., Dufort, P.A., Tartaglia, M.C., Davis, K.D., Ebraheem, A., & Hiploylee, C. (2016). Postconcussion syndrome: Demographics and predictors in 221 patients. Journal of Neurosurgery, 125(5), 12061216. doi: 10.3171/2015.6.JNS15664 Google Scholar
Wojtys, E.M., Hovda, D., Landry, G., Boland, A., Lovell, M., McCrea, M., & Minkoff, J. (1999). Current concepts. Concussion in sports. The American Journal of Sports Medicine, 27(5), 676687. doi: 10.1177/03635465990270052401 Google Scholar
Wright, M.J., McArthur, D.L., Alger, J.R., Van Horn, J., Irimia, A., Filippou, M., & Vespa, P. (2013). Early metabolic crisis-related brain atrophy and cognition in traumatic brain injury. Brain Imaging and Behavior, 7(3), 307315. doi: 10.1007/s11682-013-9231-6 CrossRefGoogle ScholarPubMed
Yengo-Kahn, A.M., & Solomon, G. (2015). Are psychotropic medications associated with differences in baseline neurocognitive assessment scores for young athletes? A pilot study. The Physician and Sportsmedicine, 43(3), 227235. doi: 10.1080/00913847.2015.1071638 Google Scholar
Yoshino, A., Hovda, D.A., Kawamata, T., Katayama, Y., & Becker, D.P. (1991). Dynamic changes in local cerebral glucose utilization following cerebral conclusion in rats: Evidence of a hyper- and subsequent hypometabolic state. Brain Research, 561(1), 106119.Google Scholar
Zuckerman, S.L., Lee, Y.M., Odom, M.J., Solomon, G.S., & Sills, A.K. (2013). Baseline neurocognitive scores in athletes with attention deficit-spectrum disorders and/or learning disability. Journal of Neurosurgery. Pediatrics, 12(2), 103109. doi: 10.3171/2013.5.PEDS12524 Google Scholar