Inaccuracy of Symptom Reporting Following Concussion in Athletes

The evaluation of the concussed athlete should involve a careful assessment of neurological markers such as amnesia, confusion and loss of consciousness. However, decisions regarding return to play are often made based largely on the self-report of symptoms and some athletes are prone to minimize symptoms to speed their return to the playing field. PURPOSE: This study was constructed to evaluate the minimization of symptoms following concussion. METHODS: A group of concussed high school and college athletes completed pre-season baseline testing (N = 91). These athletes were evaluated again at 2 and 10 days post-injury. The difference scores for the concussed group were compared to an age-matched control group (N = 27). All athletes were evaluated using the ImPACT computerized neuropsychological evaluation. In addition to neuropsychological measures, ImPACT utilizes a previously published concussion symptom index. The difference scores between this total baseline symptom score and follow-up evaluations were calculated by subtracting the baseline score from the follow-up score. A positive difference score reflects an increase in symptoms while a negative score reflects a decrease in reported symptoms. RESULTS: At 2 days post-injury, the concussed group reported significantly more symptoms relative to their own baselines compared to the control group (t = 4.03, p < .0001). However, at 10 days post-injury, the concussed group reported substantially less post-concussive symptoms than they did at baseline while the symptom reporting of the control group remained relatively stable across time (t = −2.28, p < .03). DISCUSSION: The finding of apparent minimization of symptoms following concussion supports the commonly held belief that some athletes may minimize post-concussive symptoms. Ostensibly, symptom minimization occurs in hopes of a faster return to the playing field, court or ice. This finding has a direct impact upon how return to play decisions are made following concussion in that the clinician should not rely solely on the self-report of the athlete.