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Baseline symptoms are associated with post-concussion symptom frequency and severity in college and high school athletes
  1. EF Teel1,
  2. EB Wasserman2,
  3. JK Register-Mihalik2,
  4. JP Mihalik2
  1. 1Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, USA
  2. 2Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, USA


Objective To determine the association between baseline symptoms and symptom frequency and severity one day post-concussion in college and high school athletes.

Design Prospective cohort.

Setting USA colleges (n=26) and high schools (n=210).

Subjects Concussed individuals (n=375; 314 males; 61 females) recruited from a baseline cohort (N=8,905).

Intervention Baseline presence or absence for each of the 20 items on a Graded Symptom Checklist (GSC).

Outcome measures GSC symptom frequency and severity one day post-concussion.

Results Individuals with baseline headache (χ2(1)=10.98; P<0.001), fatigue (χ2(1)=6.06; P=0.014), sleeping more than usual (χ2(1)=16.90; P<0.001), blurred vision (χ2(1)=20.48; P<0.001), light/noise sensitivity (χ2(1)=4.67; P=0.031), and mental fogginess (χ2(1)=6.08; P=0.014) reported these symptoms at a higher frequency post-concussion. Subjects reporting the following baseline symptoms had greater severity of the same symptom post-concussion: headache (Presence: median=2; IQR=1–4; Absence: median=2, IQR=0–3; P=0.004), fatigue (Presence: median=1; IQR=0–3; Absence: median=0, IQR=0–2; P=0.017), sleeping more than usual (Presence: median=1, IQR=0–3; Absence: median=0, IQR=0–0; P<0.001), blurred vision (Presence: median=1; IQR=0–2; Absence: median=0, IQR=0–0; P<0.001), sensitivity to light and noise (Presence: median=1, IQR=0–3; Absence: median=0, IQR=0–1; P=0.010), and fogginess (Presence: median=2, IQR=0–3; Absence: median=0, IQR=0–1; P=0.002). No other symptoms at baseline were associated with post-concussion symptom frequency or severity (P>0.05).

Conclusions Athletes reporting baseline symptoms, particularly those in physical and sleep-related domains, were more likely to report a higher frequency and severity of these same symptoms one day post-concussion. Understanding factors influencing post-concussion symptom recovery may inform clinical decision-making and offer selection criteria for appropriate active recovery strategies.

Competing interests None.

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