The evaluation of the concussed athlete should involve a careful assessment of neurological markers such as amnesia, confusion and loss of consciousness. However, decisions regarding return to play are often made based largely on the self-report of symptoms and some athletes are prone to minimize symptoms to speed their return to the playing field.
This study was constructed to evaluate the minimization of symptoms following concussion.
A group of concussed high school and college athletes completed pre-season baseline testing (N = 91). These athletes were evaluated again at 2 and 10 days post-injury. The difference scores for the concussed group were compared to an age-matched control group (N = 27). All athletes were evaluated using the ImPACT computerized neuropsychological evaluation. In addition to neuropsychological measures, ImPACT utilizes a previously published concussion symptom index. The difference scores between this total baseline symptom score and follow-up evaluations were calculated by subtracting the baseline score from the follow-up score. A positive difference score reflects an increase in symptoms while a negative score reflects a decrease in reported symptoms.
At 2 days post-injury, the concussed group reported significantly more symptoms relative to their own baselines compared to the control group (t = 4.03, p < .0001). However, at 10 days post-injury, the concussed group reported substantially less post-concussive symptoms than they did at baseline while the symptom reporting of the control group remained relatively stable across time (t = −2.28, p < .03).
The finding of apparent minimization of symptoms following concussion supports the commonly held belief that some athletes may minimize post-concussive symptoms. Ostensibly, symptom minimization occurs in hopes of a faster return to the playing field, court or ice. This finding has a direct impact upon how return to play decisions are made following concussion in that the clinician should not rely solely on the self-report of the athlete.