Investigation of Baseline Self-Report Concussion Symptom Scores (Original Research) (Report‪)‬

Self-reported symptoms (SRS) are a necessary component of any clinical examination. Symptoms are the basis for extending the diagnostic process, but using SRS as the only diagnostic measure after sport-related concussion is problematic. Thus, sports medicine clinicians have been encouraged to incorporate a multifaceted approach toward injury assessment and to use caution when interpreting responses to SRS scales. (1-5) The need for caution stems from the bias that may be present among athletes who are typically motivated to return to play and may feign the absence of SRS. (6) Additionally, postconcussion symptoms are by no means unique to concussive injuries. In other words, some postconcussive symptoms occur in persons who have not sustained concussions, rendering the specificity of alleged postconcussive symptoms suspect. (7-1l) Therefore, clinicians must be able to differentiate normal baseline rates of concussion-like symptoms from those directly attributable to an acute concussive incident. Summative SRS scales typically use Likert-type scaling and, as a result, offer clinicians more information than is typically obtained with simple dichotomous measures (yes, symptom is experienced versus no, symptom is not experienced). (1,9) Capturing information beyond symptom presence allows changes in SRS, including symptom duration, severity, and intensity, to be better categorized and understood. Measuring symptom duration, severity, and intensity at baseline and after injury is the most optimal method for dealing with bias related to using SRS. (1,9) Even when many of these aforementioned measurement concerns are left uncontrolled or are inconsistent, a recently published meta-analysis (2) supports the continued use of summative SRS scales as part of the multifaceted approach to concussion assessment and management. Hence, given the beneficial information provided by the responses to summative SRS scales, it becomes crucial to discuss and investigate those variables that may cause unwanted variability in SRS scores.