The Stability of Retrospective Pre-injury Symptom Ratings Following Pediatric Concussion

Elizabeth F. Teel, Roger L. Zemek, Kenneth Tang, Gerard Gioia, Christopher Vaughan, Maegan Sady, Isabelle J. Gagnon, the Pediatric Emergency Research Canada Concussion Team, Martin H. Osmond, Nick Barrowman, Stephen B. Freedman, Jocelyn Gravel, Gurinder Sangha, Kathy Boutis, Darcy Beer, William Craig, Emma Burns, Ken J. Farion

Objective: To determine the stability of children's retrospective ratings of pre-injury levels of symptoms over time following concussion. Methods: Children and adolescents (n = 3,063) between the ages of 5-17 diagnosed with a concussion by their treating pediatric emergency department (PED) physician within 48 h of injury completed the Post-Concussion Symptom Inventory (PCSI) at the PED and at 1, 2, 4, 8, and 12-weeks post-injury. At each time point, participants retrospectively recalled their pre-injury levels of post-injury symptoms. The PCSI has three age-appropriate versions for children aged 5-7 (PCSI-SR5), 8-12 (PCSI-SR8), and 13-18 (PCSI-SR13). Total scale, subscales (physical, cognitive, emotional, and sleep), and individual items from the PCSI were analyzed for stability using Gini's mean difference (GMD). Results: The mean GMD for total score was 0.31 (95% CI = 0.28, 0.34) for the PCSI-SR5, 0.19 (95% CI = 0.18, 0.20) for the PCSI-SR8, and 0.17 (95% CI = 0.16, 0.18) for the PCSI-SR13. Subscales ranged from mean GMD 0.18 (physical) to 0.31 (emotional) for the PCSI-SR8 and 0.16 (physical) to 0.31 (fatigue) for the PCSI-SR13. At the item-level, mean GMD ranged from 0.13 to 0.60 on the PCSI-SR5, 0.08 to 0.59 on the PCSI-SR8, and 0.11 to 0.41 on the PCSI-SR13. Conclusions: Children and adolescents recall their retrospective pre-injury symptom ratings with good-to-perfect stability over the first 3-months following their concussion. Although some individual items underperformed, variability was reduced as items were combined at the subscale and full-scale level. There is limited benefit gained from collecting multiple pre-injury symptom queries. Clinical Trial Registration: Clinicaltrials.gov through the US National Institute of Health/National Library of Medicine. (NCT01873287; http://clinicaltrials.gov/ct2/show/NCT01873287).