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Concussion Symptoms Predictive of Adolescent Sport-Related Concussion Injury

Harriss, Alexandra B., MSc*,†; Abbott, Kolten C., MSc*; Humphreys, David, MSc, PT*; Daley, Mark, PhD‡,§,¶; Moir, Marci Erin, MSc*; Woehrle, Emilie, BA*; Balestrini, Christopher S., MSc; Fischer, Lisa K., MD**,††; Fraser, Douglas D., MD, PhD‡‡,§§; Shoemaker, Joel Kevin, PhD*,¶¶

doi: 10.1097/JSM.0000000000000714
Brief Report: PDF Only

Objective: To assess the predictive capability of the postconcussion symptom scale (PCSS) of the sport concussion assessment tool (SCAT) III to differentiate concussed and nonconcussed adolescents.

Design: Retrospective.

Setting: Tertiary.

Participants: Sixty-nine concussed (15.2 ± 1.6 years old) and 55 control (14.4 ± 1.7 years old) adolescents.

Independent Variables: Postconcussion symptom scale.

Main Outcome Measure: Two-proportion z-test determined differences in symptom endorsement between groups. To assess the predictive power of the PCSS, we trained an ensemble classifier composed of a forest of 1000 decision trees to classify subjects as concussed, or not concussed, based on PCSS responses. The initial classifier was trained on all 22-concussion symptoms addressed in the PCSS, whereas the second classifier removed concussion symptoms that were not statistically significant between groups.

Results: Concussion symptoms common between groups were trouble falling asleep, more emotional, irritability, sadness, and anxious. After removal, analysis of the second classifier indicated that the 5 leading feature rankings of symptoms were headache, head pressure, light sensitivity, noise sensitivity, and “don't feel right,” which accounted for 52% of the variance between groups.

Conclusions: Collectively, self-reported symptoms through the PCSS can differentiate concussed and nonconcussed adolescents. However, predictability for adolescent patients may be improved by removing emotional and sleep domain symptoms.

*School of Kinesiology, Western University, London, ON, Canada;

Departments of Health and Rehabilitation Sciences;

Computer Science;


Statistics and Actuarial Science;

Anatomy and Cell Biology; and

**Family Medicine, Western University, London, ON, Canada;

††Fowler Kennedy Sports Medicine Clinic, Western University, London, ON, Canada;

‡‡Department of Paediatrics, Western University, London, ON, Canada;

§§Children's Health Research Institute, London, Ontario, Canada; and

¶¶Department of Physiology and Pharmacology, Western University, London, ON, Canada.

Corresponding Author: J. Kevin Shoemaker, PhD, School of Kinesiology, Western University, 1151 Richmond St, London, ON N6A 5B9, Canada (

This study was funded by the Children's Health Foundation.

The authors report no conflicts of interest.

Received January 26, 2018

Accepted October 13, 2018

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