Concussion-Like Symptoms in Child and Youth Athletes at Baseline: What Is "Typical"?

Context: After a concussion, guidelines emphasize that an athlete should be asymptomatic before starting a return-to-play protocol. However, many concussion symptoms are nonspecific and may be present in individuals without concussion. Limited evidence exists regarding the presence of "typical" or preinjury (baseline) symptoms in child and youth athletes.

Objective: To describe the frequency of symptoms reported at baseline by child and youth athletes and identify how age, sex, history of concussion, and learning factors influence the presence of baseline symptoms.

Design: Cross-sectional cohort study.

Setting: Baseline testing was conducted at a hospital research laboratory or in a sport or school setting (eg, gym or arena).

Patients Or Other Participants: A total of 888 child (9-12 years old, n = 333) and youth (13-17 years old, n = 555) athletes participated (46.4% boys and 53.6% girls, average age = 13.09 ± 1.83 years).

Main Outcome Measure(s): Demographic and symptom data were collected as part of a baseline protocol. Age-appropriate versions of the Post-Concussion Symptom Inventory (a self-report concussion-symptoms measure with strong psychometric properties for pediatric populations) were administered. Demographic data (age, sex, concussion history, learning factors) were also collected.

Results: Common baseline symptoms for children were feeling sleepier than usual (30% boys, 24% girls) and feeling nervous or worried (17% boys, 25% girls). Fatigue was reported by more than half of the youth group (50% boys, 67% girls). Nervousness was reported by 32% of youth girls. Headaches, drowsiness, and difficulty concentrating were each reported by 25% of youth boys and girls. For youths, a higher total symptom score was associated with increasing age and number of previous concussions, although these effects were small (age r = 0.143, number of concussions r = .084). No significant relationships were found in the child group.

Conclusions: Children and youths commonly experienced symptoms at baseline, including fatigue and nervousness. Whether clinicians should expect complete symptom resolution after concussion is not clear.