title: The Postconcussion Symptom Scale: utility of a three-factor structure.
abstract: OBJECTIVE
  This study aimed to determine the factor structure of a 19-item Postconcussion Symptom Scale and to examine associations between factor scores and sex, previous history of concussion, and length of time since injury.
  
  
  METHODS
  This is a retrospective medical record review of pediatric patients with concussion seen in a sports medicine clinic from April 2008 to September 2012. We performed an exploratory factor analysis (EFA) followed by a confirmatory factor analysis (CFA). ANOVA and regression analysis were used to examine associations between factor scores and sex, previous history of concussion, mood disorder, anxiety disorder or attention-deficit disorder, and length of time since injury.
  
  
  RESULTS
  EFA supported a three-factor solution for postconcussive symptoms employing 18 of the original 19 scale items. Factor 1 consisted of eight cognition-related items, factor 2 consisted of six somatic-related items, and factor 3 consisted of four emotional-related items. CFA results confirmed the unidimensionality of factors 1 (neurocognitive), 2 (somatic) and 3 (emotional), with factor 3 being considered borderline. Females and patients with anxiety disorders had significantly worse (higher) scores on all three factors. Patients seen >14 d after the concussive injury had worse (higher) factor 3 (emotional) scores than those seen <14 d after the injury. There was no significant difference in postconcussive symptom factor structures between those with and without a previous history of concussion.
  
  
  CONCLUSIONS
  Our investigation demonstrates a consistent symptom 3-factor structure of the Postconcussion Symptom Scale in pediatric patients with concussions. Females and patients with anxiety disorders had higher scores than males for all three factors. Patients seen >14 d after concussive injury had higher scores for emotional symptoms, suggesting that prolonged concussion symptoms may affect emotional health.
authors.affiliation: 1Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; 2Department of Pediatrics, Northwestern University's Feinberg School of Medicine, Chicago, IL; 3Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; 4Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; and 5Department of Psychiatry and Behavioral Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL.
authors.forename: Aisha S
authors.initials: AS
authors.lastname: Joyce
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Labella
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Carl
authors.forename: Jin-Shei
authors.initials: JS
authors.lastname: Lai
authors.forename: Frank A
authors.initials: FA
authors.lastname: Zelko
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000175:diagnosis*; D002648:Child; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D038223:Post-Concussion Syndrome / Q000175:diagnosis*; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D055815:Young Adult