The Influence of the COVID-19 Pandemic on Baseline Concussion Symptom Assessments Among Adolescents

Introduction The COVID-19 pandemic resulted in the cancellation of high school sports in spring 2020, a modifiedresumption of sports in the 2020-2021 academic year, and a return to pre-pandemic sports in 2021-2022.This cancellation had a major impact on the quality of life of adolescent athletes, but it is unknown exactlyhow these pandemic-driven sports disruptions on athlete baseline (preseason) symptoms affected quality oflife. Therefore, the current study retrospectively evaluated symptom inventories from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assessments to determine whether the cancellationof sports during the COVID-19 pandemic affected baseline (preseason) self-reported symptoms amongadolescent athletes. Methods Our study used a retrospective cohort design to evaluate high school athletes with complete ImPACTassessments in the academic years before (2018-2019 and 2019-2020), during (2020-2021), and after (2021-2022) the pandemic. Specifically, data from a 22-item symptom report called the Post-Concussion SymptomScale (PCSS) assessed during ImPACT was collected and analyzed using generalized linear models with aTweedie exponential dispersion model and post hoc Tukey's honestly significant difference tests. The mainoutcomes were the total symptom severity score and the affective cluster score. Secondary outcomes werethe analysis of the vestibular-somatic, cognitive-sensory, and sleep-arousal symptom clusters. Results Of the 104,274 ImPACT assessments, the total symptom severity score on the PCSS was different acrossyears (p<0.001). There were lower symptom scores in 2020-2021 (5.33, 95% CI = 5.13-5.54) than in 2018-2019 (6.82, 95% CI = 6.63-7.01), 2019-2020 (6.94, 95% CI = 6.75-7.14), and 2021-2022 (6.44, 95% CI = 6.25-6.64). The cluster scores on the PCSS for affective, cognitive-sensory, sleep-arousal, and vestibular-somaticwere also lower (p<0.001) in 2020-2021 than in 2018-2019, 2019-2020, and 2021-2022. Conclusion Contrary to our expectations, total symptom severity and cluster scores on the PCSS during the pandemic(2020-2021) were significantly lower than during the years before and after the pandemic-driven sportsdisruptions, suggesting the pandemic did not negatively affect these athletes as expected. These results alsosuggested that self-reported symptoms utilized in the PCSS component of ImPACT may not be as sensitiveto sports disruption among adolescent athletes as other quality-of-life measures, especially during theCOVID-19 pandemic