Determinants of Symptom Presentation and Resolution Following Concussions in High School Sports

Epidemiological studies of sport-related concussions (SRCs) in high school (HS) sports have provided meaningful clinical insights. However, the correlates of, and dynamic relationships between acute clinical symptoms remain unknown. PURPOSE: To examine patterns in SRC symptom presentations among HS athletes and determine how symptom presentations predict symptom resolution time (SRT) in this population. METHODS: SRCs in HS sports captured within HS Reporting Information Online (RIO) during the 2014/15-2018/19 academic years were examined. Symptom prevalence (expressed as %s) was assessed across covariables of sex, event type, injury mechanism, class year, and sport type. We used multivariate logistic regression models (separately for boys’ and girls’ sports) using an odds ratio (OR) dependence structure to identify pairwise associations between reported symptoms. We also used multivariable ordinal logistic regression modelling to identify clinical predictors of SRT (characterized as <7 days, 7-21 days, ≥22 days). Effect estimates with associated 95% Confidence Intervals (CIs) excluding 1.00 were considered statistically significant. RESULTS: A total of 5,957 SRCs in boys’ sports and 3,019 in girls’ sports were analyzed. In both groups, difficulty concentrating, light sensitivity, noise sensitivity, and disorientation were symptoms with the strongest dependencies with other symptoms (Figure 1). Greater counts of these four symptoms were associated with odds of longer SRT (ORadj. = 1.35; 95% CI = [1.30, 1.40]). CONCLUSIONS: Findings indicate that specific SRC symptom presentations may be considered during sideline and subsequent clinical assessments to guide targeted assessment and management strategies. Concurrent presentations of physical and cognitive symptoms such as difficulty concentrating, light sensitivity, noise sensitivity, and disorientation may predicate longer clinical recovery times in HS athletes.