Do Initial Symptom Factor Scores Predict Subsequent Impairment Following Concussion?

OBJECTIVE

Symptom factors present during the first week following concussion may predict subsequent concussion outcomes and recovery duration. We hypothesized that a high loading on cognitive-fatigue-migraine and somatic factors would be predictive of neurocognitive impairment following concussion. We also hypothesized that the affective factor would be related to vestibular symptoms and impairment.

DESIGN

Prospective repeated measures.

SETTING

Concussion specialty clinic.

PARTICIPANTS

Athletes aged 13 to 20 years diagnosed with a concussion within the past 7 days.

INDEPENDENT VARIABLE

Symptom factors at the initial visit 1 to 7 days after injury.

MAIN OUTCOME MEASURE

Symptom factor score, neurocognitive testing, and vestibular/ocular motor assessment at the second visit (2-4 weeks after injury).

RESULTS

The somatic symptom factor from the initial visit was significant (P < 0.05) in all vestibular/ocular screening components (P < 0.05) but not neurocognitive test performance (P > 0.05) at the second visit. The cognitive-migraine-fatigue and affective symptom factors predicted symptom burden at the second visit (P < 0.001) but did not predict recovery time (P = 0.200).

CONCLUSIONS

The somatic symptom factor during the first week after injury predicted symptom provocation during vestibular/ocular screening at 2 to 4 weeks after injury. Specifically, higher scores on somatic symptom factor at the initial visit predicted worse symptom reporting for all vestibular/ocular screening components at the second visit. Patients with higher scores on the cognitive-migraine-fatigue and affective symptom factors at the initial visit predicted total symptom burden at the second visit.