title: Differential diagnosis of dizziness after a sports-related concussion based on descriptors and triggers: an observational study.
abstract: BACKGROUND
  Dizziness is often reported after a sports-related concussion. Forces experienced at the time of the concussion can cause an injury to multiple anatomical areas, including the central nervous system, the vestibular system, and the cervical spine, each of which is sufficient to cause dizziness. Medical professionals routinely use the subjective history to develop hypotheses about what may be causing a patient's dizziness. No previous studies have attempted to differentiate the source of the dizziness through precise patient descriptors or the triggers of dizziness.
  
  
  METHODS
  A structured symptom questionnaire was developed through purposive exploration of relevant literature for common dizziness quality descriptors and triggers. This questionnaire was used to interview a sample of 86 adolescent athletes (12-19 years of age) with a sports-related concussion between August 2013 and April 2014. Exploratory Latent Class Analysis was used to uncover latent constructs within the 15 dizziness descriptors and 11 dizziness triggers. The covariates sex, attention deficit hyperactivity disorder, and number of days between the concussion and the assessment were added to the model to estimate if these variables influenced class membership probabilities.
  
  
  RESULTS
  Thirty-two (36 %) of the patients interviewed did not report a complaint of dizziness but did affirm one or more of the other descriptors. Three classes of dizziness based on dizziness quality descriptors and three classes based on dizziness triggers were identified by the analysis. Neither the classes of descriptors nor the classes of triggers enabled differentiation based on anatomical etiology of the dizziness.
  
  
  CONCLUSIONS
  Patient description of dizziness is limited in its ability to assist in differential diagnosis based on anatomical location for athletes with concussion. This may be because more than one area is contributing to the dizziness or because concussed adolescents have difficulty describing the way that they feel. In this case, solely relying on the patient to provide a description of dizziness to develop the formation of hypotheses and lead the direction of objective tests is inappropriate. If the scope of the objective assessment is limited by the patient description of dizziness, it is likely that areas of dysfunction may be overlooked.
authors.affiliation: Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, USA. JReneker@Walsh.edu.|Physical Therapy Program, Division of Health Sciences, Walsh University, North Canton, OH, USA. JReneker@Walsh.edu.
authors.forename: Jennifer C
authors.identifier: http://orcid.org/0000-0003-3617-5681
authors.initials: JC
authors.lastname: Reneker
authors.affiliation: Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, USA.
authors.forename: Vinay
authors.initials: V
authors.lastname: Cheruvu
authors.affiliation: Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Department Of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Jingzhen
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Physical Therapy, Department of Orthopaedics, Duke University, Durham, NC, USA.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Cook
authors.affiliation: Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: James
authors.affiliation: Physical Therapy Service, Community Based Outpatient Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
authors.forename: M Clay
authors.initials: MC
authors.lastname: Moughiman
authors.affiliation: Center for Orthopedics and Sports Medicine, Akron Children's Hospital, Considine Professional Building, Akron, OH, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Congeni