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Concussion Signs and Symptoms

Different symptoms for children aged 5 to 12: Child SCAT3 

The use of these symptom scales has yet to be adequately studied in the grade-school athlete.  Because athletes below age 13 report symptoms different from adults, and a clinical evaluation by the health care professional should include input not only from the athlete but from parents, and possibly teachers and school personnel, [1] the Zurich concussion conference resulted in the issuance of a new Child SCAT3 [12] for use in assessing concussion for children aged 5-12 years, which includes symptom scales to be completed by the child and their parent: 

                                                            Child - SCAT3 Symptom Evaluation

 

CHILD REPORTNeverRarelySometimesOften
1. I have trouble paying attention        
2. I get distracted easily        
3. I have a hard time concentrating        
4. I have problems remembering what people tell me        
5, I have problems following directions        
6. I daydream too much        
7. I get confused        
8. I forget things        
9. I have problems finishing things        
10. I have trouble figuring things out         
11. It's hard for me to learn new things        
12. I have headaches        
13, I feel dizzy        
14. I feel like the room is spinning        
15. I feel like I'm going to faint        
16. Things are blurry when I look at them        
17. I see double        
18. I feel sick to my stomach        
19. I get tired a lot        
20. I get tired easily        
21. Difficulty remembering        
22. Visual problems
       

 

 

Parent reportNeverRarelySometimes Often
The child:        
1. has trouble sustaining attention        
2. is easily distracted        
3. has difficulty concentrating        
4. has problems remembering what he/she is told        
5. has difficulty following directions        
6. tends to daydream        
7. gets confused        
8. is forgetful        
9. has difficulty completing tasks        
10. has poor problem solving skills        
11. has problems learning        
12. has headaches        
13. feels dizzy        
14. has a feeling the room is spinning        
15. feels faint        
16. has blurred vision        
17. has double vision        
18. experiences nausea        
19. gets tired a lot        
20. gets tired easily        

As with the other symptoms scales, however, the child- and parent-symptom scales have not yet been the subject of large scale, controlled studies to establish their effectiveness in identifying young athletes with concussion. 

Critical component of concussion assessment

Symptom scales by themselves do not diagnose whether a concussion has occurred; rather, they provide information that can help a health care professional in making an overal diagnosis, in gauging injury severity, in assessing recovery, and in making the all-important return-to-play determination, although because of the unreliability of athletes' reports of being symptom-free [14] and a "good old days bias" [19] (the normal human tendency to selectively remember being healthier in the past and to fail to remember having health problems, which, in the context of mTBI, could play a role in the perceived persistence of post-concussion symptomatology by minimizing the likelihood that such symptoms existed prior to the injury and attributing the current symptoms directly to the injury) they are only one factor. [2]  

As the authors of a 2013 study [2] noted, "[a]lthough concerns are routinely expressed about athletes under-reporting concussion or the resulting symptoms," [15] their "review suggests that symptom assessment remains a critical component of concussion assessment. ... In sum, the literature clearly supports the continued use of symptom scales in the assessment of concussed athletes, ideally in combination with other functional [(e.g. neurocognitivebalance)] tests." 

Another 2013 study [19] while saying that symptom scales "remain the gold standard for determining outcome" after mild traumatic brain injury, noted that they "remain one of the very few scales without good normative data comparisons," and called for the development of such data and reliable change indices for symptom scales to ovecome the "good old days" bias.


1. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.

2. Mcrea M, Iverson G, Echemendia, et al. Day of injury assessment of sport-related concussion.  Br J Sports Med 2013;47:272-284.

3.  SCAT3. Br J Sports Med 2013;47:259  

4. Marar M, McIlvain NM, Fields SK, Comstock RD. Epidemiology of Concussions Among United States High School Athletes in 20 Sports. Am J Sports Med 2012;40(4):747-755. 

5. Symptom descriptions courtesy of Robin Karpf,M.D., Medical Director, Al Rashid Health and Wellness Center, The Lawrenceville School, Lawrenceville, New Jersey.

6.  Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed following sports-related concussion. J Clin Exp Neuropsychol. 2005; 27(6):683-689.

7.  Lau BC, Kontos AP, Collisn MW, Mucha A, Lovell MR. Which On-Field Signs/Symptoms Predict Protracted Recovery From Sport-Related Concussion Among High School Football Players?  Am J. Sports Med 2011;20(10) DOI:10.1177/0363546511410655 (published June 28, 2011 online ahead of print)(accessed November 5, 2011).

8. Duhaime A, Beckwith J, Maerlender A, McAllister T, Crisco J, Duma S, et. al.  Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets.  J Neurosurg 2012;117:1092-1099. 

9. Ellenbogen R.  Sports and concussion.  J Neurosurg 2012;117:1089-1091. 

10. Frommer L, Gurka K, Cross K, Ingersoll C, Comstock R.D., Saliba S. Sex Differences in Concussion Symptoms of High School Athletes. J Ath. Train. 2011;46(1):000-000.  

11. Meehan W, d'Hemecourt P, Comstock D, High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management. Am J Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc).

12.  Child SCAT3. Br J Sports Med 2013;47:263.

13. Pardini D, Stump JE, Lovell MR, Collins MW, Moritz K, Fu FH. The post-concussion symptom scale (PCSS): a factor analysis. Br. J Sports Med. 2004;38:661-662. 

14.  Sandel N, Lovell M, Kegel N, Collins M, Kontos A. The Relationship Of Symptoms and Neurocognitive Performance to Perceived Recovery From Sports-Related Concussion Among Adolescent Athletes. Applied Neuropsychology: Child. 2012; DOI:10.1080/21622965.201 2.670680 (published online ahead of print 22 May 2012)(accessed June 5, 2012)

15. McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players - Implications for prevention. Clin J Sport Med 2004;14:13-17. 

16. Harmon K, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport.  Br J Sports Med 2013;47:15-26. 

17. Giza C, Kutcher J, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology.  (published online ahead of print, March 18, 2013); DOI: 10.1212/WNL.ob013e31828d57dd (accessed March 25, 2013)

18. Halstead, M, Walter, K. Clinical Report - Sport-Related Concussion in Children and Adolescents. Pediatrics 2010;126(3): 597-615 at n.60.  

19.  Brooks BL, Kadoura B, Turley B, Crawford S, Mikrogianakis A, Barlow KM. Perception of Recovery After Pediatric Mild Traumatic Brain Injury Is Influenced by the "Good Old Days" Bias: Tangible Implications for Clinical Practice and Outcomes Research. Arch Clin Neurospych. 2013;doi:10.1093/arcclin/act083 (epub November 5, 2013)

20. Reneker JC, Cook CE. Dizziness after sports-related concussion: Can physiotherapists offer better treatment than just 'physical and cognitive rest'? Br J Sports Med 2015;49:491-492. originally published online July 17, 2014. 

Additional sources:

Blinman TA, Houseknecht E, Snyder C, Wiebe DJ, Nance ML. Postconcussive symptoms in hospitalized pediatric patients after
mild traumatic brain injury. J Pediatr Surg. 2009;44(6):1223-1228.

Gioia, GA. Schneider JC. Vaughan CG. Isquith PK. Which symptom assessments and approaches are uniquely appropriate for pediatric concussion? Br. J. Sports Med. 2009; 43 (suppl1): i13-i22..

Pocket Concussion Recognition Tool. Br J Sports Med 2013;47:267. 

Most recently updated April 30, 2016


 

 

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