How much time has passed between a sports-related concussion and evaluation can affect symptom reporting with scales like the Post-Concussion Symptom scale, according to a new study.
Timing Can Affect Concussion Symptom Score
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Secondary#concussion#concussionsymptomcutoffs#concussionsymptonscale
The study, “Concussion Symptom Cutoffs for Identification and Prognosis of Sports-Related Concussion: Role of Time Since Injury, was published July 21, 2020 in The American Journal of Sports Medicine. This is the first study to evaluate changes in clinical cutoff scores for the Post-Concussion Symptom Scale (PCSS).
The researchers conducted a chart review of clinical data from 887 patients with sports-related concussion who were evaluated at a concussion specialty clinic.
They were each categorized based on the time of injury, early (within 7 days) or late (within 8-21 days). The outcomes were total symptom severity (total PCSS score) and total score for each of the following symptom factors: cognitive/migraine/fatigue (CMF), affective, sleep, and somatic.
The patients with concussions were compared to a healthy control group. The athletes in the early concussion group had markedly different scores than the healthy controls with a cutoff of 7 or less for the CMF factor, one or less for affective factor and seven or less for total PCSS score.
The late presentation group had a reduced cutoff of less than 4 for the CMF factor, but the other scores were similar to those concussion patients who had gotten evaluated earlier.
Overall, in the early presentation group the CMF factor was the strongest predictor of a longer recovery (cutoff, ≥23) followed by the total PCSS and affective factor. In the late group, the affective factor (cutoff, ≥1), and total PCSS (cutoff, >35) had the greatest predictability, but the cutoff threshold was reduced.
The researchers wrote, “The findings indicate that PCSS symptom clinical cutoffs for identifying injury and recovery prognosis change on the basis of time since injury. Specifically, the combination of CMF, affective, and sleep factors is the best differentiator of athletes with sports-related concussion from controls regardless of time since injury.”
They added, “Furthermore, the CMF factor is the most robust predictor of prolonged recovery if the patient is within 1 week of sports-related concussion, whereas, the affective factor is the most robust predictor of prolonged recovery if the patient is within 2 to 3 weeks of sports-related concussion.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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