Preinjury and Injury-Related Risk Factors Associated With Concussion Clinical Profiles Screening (CP Screen) and Clinician-Adjudicated Profiles.

OBJECTIVE

To examine the association of select demographic, medical history, and injury-related factors to Concussion Clinical Profile Screening (CP Screen) scores and clinician-adjudicated profiles in patients following concussion.

SETTING

This study used an outpatient concussion specialty clinic setting.

PARTICIPANTS

Of 5024 patients, 242 participants aged 9 to 51 years ( M = 15.66, SD  = 4.1) were selected who were diagnosed with a concussion at their initial visit within 30 days, had no moderate to severe traumatic brain injury, and had no neurological, substance use, vestibular, or ocular disorders.

DESIGN

This is a retrospective cross-sectional study with masked intervention clinicians.

MAIN MEASURES: The scores of 5 CP Screen profiles (anxiety/mood, cognitive/fatigue, posttraumatic migraine, vestibular, and ocular) and 2 modifiers (sleep and cervical) were correlated with masked clinician-adjudicated clinical profiles. Multiple backward stepwise linear regressions were used to predict scores on the CP Screen. Adjudicated clinical profiles were predicted using multiple backward stepwise logistic regressions (LR) with receiver operating curve analyses of the areas under the curve. CP Screen scores and adjudicated profiles were compared using point biserial correlations.

RESULTS

Most risk factors were related to one or more CP Screen scores ( P < .05). Multiple LRs for clinician-adjudicated profiles revealed depression history (OR = 7.58), attention-deficit/hyperactivity disorder learning disabilities (ADHD/LD) history (OR = 2.67), and non-sport-related concussions (non-SRC; OR = 0.27) predicted anxiety/mood profile (area under the curve [AUC] = 0.74, P < .001). Motion sickness history (OR = 0.47) predicted posttraumatic migraine profile (AUC = 0.64, P = .01). ADHD/LD history (OR = 2.67) predicted cognitive/fatigue profile (AUC = 0.65, P = .01). All CP Screen scores correlated with the adjudicated anxiety/mood profile ( r = 0.20-0.47, P < .05) and most scores with vestibular profile ( r = 0.13-0.36, P < .05). Posttraumatic migraine ( r = -0.13 to 0.32, P < .05) and ocular ( r = 0.15-0.34, P < .05) profile scores correlated with most clinical profile adjudications.

CONCLUSIONS

Numerous preinjury and injury-related factors are useful for identifying CP Screen scores. However, only few factors predicted respective clinician-adjudicated profiles also. These findings highlight the utility of these factors for concussion care and the injury's multifaceted nature.