Association between Previous Concussion History and Symptom Endorsement during Preseason Baseline Testing in High School and Collegiate Athletes

BACKGROUND: A graded symptom checklist is a commonly used concussion evaluation measure. Little is known about preseason baseline symptomatology of high school and college athletes with and without a previous concussion history. HYPOTHESIS: The primary hypothesis investigated was that those individuals with a concussion history would report more symptoms at baseline testing. The effects of sex and age on symptoms were also examined. STUDY DESIGN: Cross-sectional study. METHODS: Subjects included 8930 high school and collegiate athletes (height, 177.79 ± 9.97 cm; mass, 75.20 ± 19.21 kg; age, 16.60 ± 1.64 years). Subjects completed a self-report graded symptom checklist and concussion history questionnaire during a preseason clinical testing session. Symptoms reported (yes or no) on the 18-item graded symptom checklist served as the dependent variables. RESULTS: A significant association was observed between symptoms on the graded symptom checklist and previous concussion history (P ≤ .001). No differences were observed between high school and college athletes regarding symptom endorsement (t(8928) = 0.620; P = .535). A statistical but not clinically meaningful difference was observed between the means for males and females symptom endorsement (t(8928) = −3.03; P = .002): men endorsed 1.88 ± 2.81 symptoms, and women endorsed 2.09 ± 2.90 symptoms. Headache, sleeping more than usual, difficulty concentrating, drowsiness, difficulty remembering, fatigue, difficulty sleeping, and irritability were reported by more than 10% of athletes. CONCLUSION: High school and college athletes with a history of multiple concussions may be at risk for experiencing concussion-linked symptoms well beyond the acute stage of injury. Clinicians should be mindful of previous concussion history in athletes with increased presence of base-rate symptoms as they may be predisposed to future injury.