title: The underreporting of self-reported symptoms following sports-related concussion.
abstract: OBJECTIVE
  This cohort study was conducted to examine patterns of symptom reporting in concussed athletes in two different testing environments.
  
  
  METHODS
  A prospective cohort study was conducted with repeated measures.
  
  
  METHODS
  Self-reported symptoms collected by team athletic trainers using the ImPACT Post-Concussion Scale (PCS) were compared to symptoms collected in a confidential setting using structured interviews for depression and anxiety. Ratings were scaled to match scoring of the PCS and categorized into symptom-domains. Scores collected 2 days post-concussion were compared across different rating scales. Confidential self-report scores approximately 9 days post-concussion in cleared athletes were compared to PCS scores collected during return-to-play decisions. Finally, confidential self-report scores collected 9 days post-concussion were compared between cleared and not cleared athletes.
  
  
  RESULTS
  Athletes self-reported significantly fewer symptoms to team athletic trainers using the ImPACT test compared to self-reported symptoms collected in a confidential setting during the acute phase of concussion using standard psychiatric interviews. Athletes cleared to play continued to underreport symptoms 9 days post-concussion, particularly psychiatric symptoms. Finally, cleared athletes self-reported similar magnitude of symptoms than non-cleared athletes 9 days post-concussion in confidential research setting.
  
  
  CONCLUSIONS
  The systematic underreporting of post-concussion symptoms may represent motivated behavior or differences in self-reporting data acquisition. By underreporting symptoms, many cleared athletes are still symptomatic over 1-week post-concussion. This study highlights the need for objective measures for somatic and psychiatric symptoms.
authors.affiliation: Laureate Institute for Brain Research, Tulsa, OK, USA. Electronic address: tmeier@laureateinstitute.org.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Meier
authors.affiliation: Department of Psychology, The University of Tulsa, Tulsa, OK, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Brummel
authors.affiliation: Laureate Institute for Brain Research, Tulsa, OK, USA.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Athletics, The University of Tulsa, Tulsa, OK, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Nerio
authors.affiliation: Department of Athletics, The University of Tulsa, Tulsa, OK, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Polanski
authors.affiliation: Laureate Institute for Brain Research, Tulsa, OK, USA; Faculty of Community Medicine, The University of Tulsa, Tulsa, OK, USA.
authors.forename: Patrick S F
authors.initials: PS
authors.lastname: Bellgowan
mesh_terms: D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D001265:Athletic Injuries / Q000175:diagnosis* / Q000523:psychology; D001924:Brain Concussion / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D000068958:Return to Sport / Q000523:psychology*; D057566:Self Report; D055815:Young Adult
keywords: Mild traumatic brain injury; Neuropsychological testing; Post-concussion symptoms