Identification of sport and recreational activity concussion history through the preparticipation screening and a symptom survey in young athletes

Objective: To evaluate the concussion history of young athletes using three questions on the preparticipation screening (PPS) and a concussion symptom survey (CSS). Design: Descriptive survey. Setting: Mass high school PPS. Patients or Other Participants: Five hundred twenty young athletes. Interventions: Athletes were asked about their concussion history using three different questions on the PPS. The CSS, a list of concussion-related symptoms, was also given to assess the history of concussion-related symptoms associated with a previous injury to the head. Main Outcome Measures: Positive concussion history was determined as a positive response on one of the three PPS questions or any one of the CSS responses and reported as frequencies and percentages. Kappa coefficients were used to evaluate the agreement between the responses on the three PPS questions. Results: There was little agreement among the three PPS questions, with kappa coefficients ranging from K = -0.018 to 0.342. Analysis of the CSS revealed that 286 athletes (55.0%) reported having at least one concussion symptom after a head injury. Of those reporting symptoms, 86.4% did not report a concussion history in sport, and 92.7% did not report a concussion history in recreational activities. Conclusions: The identification of concussion history may depend on the phrasing of questions on the PPS. Simply asking an athlete whether they had a concussion may not adequately identify athletes with concussion histories. Although recommendations have been made to avoid the terminology of ding and bell rung, it seems these terms may be needed to ensure adequate reporting of previous concussions in young athletes.