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Concussion Symptom Profiles Among Child, Adolescent, and Young Adult Athletes

Howell, David R. PhD, ATC*,†,‡; Kriz, Peter MD§; Mannix, Rebekah C. MD, MPH¶,‖; Kirchberg, Tyler BS§; Master, Christina L. MD**,††; Meehan, William P. III MD‡,‖,‡‡

Clinical Journal of Sport Medicine: September 2019 - Volume 29 - Issue 5 - p 391–397
doi: 10.1097/JSM.0000000000000629
Original Research

Objectives: (1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptom profiles are associated with duration of postconcussion symptoms, and whether they vary by age group.

Design: A total of 689 patients (20% children 7-12 years of age, 69% adolescents 13-18 years of age, and 11% young adults 19-30 years of age) were seen and diagnosed with a concussion within 21 days after injury. Patients completed the Post-Concussion Symptom Scale (PCSS) and were followed until they no longer required care.

Setting: Two specialty care sport concussion clinical practices.

Main outcome measures: Overall PCSS score was obtained, as well as severity ratings from somatic, vestibular–ocular, cognitive, sleep, and emotional symptom domains. We also calculated total symptom duration time.

Results: No significant main effect of age, or age by sex associations were identified among the symptom domains. Females endorsed a higher somatic symptom severity rating than males (9.8 ± 6.7 vs 8.1 ± 6.7; P = 0.03). For patients between 7 and 12 years of age, higher somatic [β-coefficient = 1.57, 95% confidence interval (CI), 1.47-1.67] and cognitive (β-coefficient = 2.50, 95% CI, 2.32-2.68) symptom severities were associated with longer duration of concussion symptoms. Among adolescents, longer total symptom duration was associated with more severe somatic (β-coefficient = 1.25, 95% CI, 0.34-2.15) and vestibular–ocular (β-coefficient = 2.36, 95% CI, 1.49-3.23) symptoms.

Conclusions: Within 21 days after concussion, symptom-reporting behavior seems to be similar across the age spectrum, but the relationship between symptom profiles and time to symptom resolution varies by age. Although overall symptom ratings are beneficial in determining clinical pathways, symptom domain use may provide a beneficial method to determine individualized patient care that differs between children and adolescents after concussion.

*Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado;

Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado;

The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts;

§Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School, Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island;

Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts;

Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;

**Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;

††Division of Sports Medicine, Department of Orthopedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and

‡‡Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts.

Corresponding Author: David R. Howell, PhD, ATC, Sports Medicine Center, Children's Hospital Colorado, 13123 East 16th Ave, Aurora, CO 80045 (

D. R. Howell's research is funded, in part, through a research contract between Boston Children's Hospital, Cincinnati Children's Hospital Medical Center, and ElMindA Ltd. W. P. Meehan receives royalties from (1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; (2) Springer International for the book Head and Neck Injuries in Young Athlete, and (3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and by a grant from the Football Players Health Study at Harvard University, which is funded by the NFL Players Association.

The authors report no conflicts of interest related to the current study.

Received November 28, 2017

Accepted April 20, 2018

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