title: Factors Associated With Concussion-like Symptom Reporting in High School Athletes.
abstract: OBJECTIVE
  Every state in the United States has passed legislation for sport-related concussion, making this health issue important for physicians and other health care professionals. Safely returning athletes to sport after concussion relies on accurately determining when their symptoms resolve.
  
  
  OBJECTIVE
  To evaluate baseline concussion-like symptom reporting in uninjured adolescent student athletes.
  
  
  METHODS
  In this cross-sectional, observational study, we studied 31 958 high school athletes from Maine with no concussion in the past 6 months who completed a preseason baseline testing program between 2009 and 2013.
  
  
  RESULTS
  Symptom reporting was more common in girls than boys. Most students with preexisting conditions reported one or more symptoms (60%-82% of boys and 73%-97% of girls). Nineteen percent of boys and 28% of girls reported having a symptom burden resembling an International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS). Students with preexisting conditions were even more likely to endorse a symptom burden that resembled PCS (21%-47% for boys and 33%-72% for girls). Prior treatment of a psychiatric condition was the strongest independent predictor for symptom reporting in boys, followed by a history of migraines. For girls, the strongest independent predictors were prior treatment of a psychiatric condition or substance abuse and attention-deficit/hyperactivity disorder. The weakest independent predictor of symptoms for both sexes was history of prior concussions.
  
  
  CONCLUSIONS
  In the absence of a recent concussion, symptom reporting is related to sex and preexisting conditions. Consideration of sex and preexisting health conditions can help prevent misinterpretation of symptoms in student athletes who sustain a concussion.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts2Spaulding Rehabilitation Hospital, Boston, Massachusetts3MassGeneral Hospital for Children Sports Concussion Program, Boston4Red Sox Foundation and Massachus.
authors.forename: Grant L
authors.initials: GL
authors.lastname: Iverson
authors.affiliation: Division of Physical Medicine and Rehabilitation, University of British Columbia, and GF Strong Rehab Centre, Vancouver, British Columbia, Canada.
authors.forename: Noah D
authors.initials: ND
authors.lastname: Silverberg
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Mannix
authors.affiliation: Department of Computer Science, Colby College, Waterville, Maine.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Maxwell
authors.affiliation: Department of Psychology, Colby College, Waterville, Maine.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Atkins
authors.affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts3MassGeneral Hospital for Children Sports Concussion Program, Boston4Red Sox Foundation and Massachusetts General Hospital Home Base Program Boston.
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
authors.affiliation: Health Services and Department of Biology, Colby College, Waterville, Maine.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Berkner
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000453:epidemiology*; D001924:Brain Concussion / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors; D012574:Schools; D013334:Students; D014481:United States