title: High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes.
abstract: BACKGROUND
  Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined.
  
  
  OBJECTIVE
  To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  High school and collegiate athletic programs.
  
  
  METHODS
  A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68).
  
  
  METHODS
  Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment.
  
  
  RESULTS
  The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group.
  
  
  CONCLUSIONS
  Reported baseline symptoms may help identify athletes at risk for worse outcomes after SRC. Clinicians should examine baseline symptom levels to better identify patients for earlier referral and treatment for their injury. Additional investigation of baseline symptoms is warranted to help delineate the type and severity of premorbid symptoms.
authors.affiliation: Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA;
authors.forename: Aimee
authors.initials: A
authors.lastname: Custer
authors.affiliation: Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA;
authors.forename: Alicia
authors.initials: A
authors.lastname: Sufrinko
authors.affiliation: University of Arkansas, Fayetteville;
authors.forename: R J
authors.initials: RJ
authors.lastname: Elbin
authors.affiliation: Michigan State University, East Lansing.
authors.forename: Tracey
authors.initials: T
authors.lastname: Covassin
authors.affiliation: Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA;
authors.forename: Micky
authors.initials: M
authors.lastname: Collins
authors.affiliation: Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA;
authors.forename: Anthony
authors.initials: A
authors.lastname: Kontos
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis*; D001924:Brain Concussion / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis*; D011379:Prognosis; D011930:Reaction Time; D012307:Risk Factors; D013334:Students
keywords: baseline testing; neurocognitive impairment; traumatic brain injuries