Detection Of Head Injury In Collegiate Athletes

Objective: The purpose of this study was to assess the accuracy of a University Preparticipation Physical Evaluation (PPE) questionnaire in identifying concussion(s) in collegiate athletes. Design: A comparison of two retrospective survey instruments. Participants: Prior to the 2002 Fall season, 172 male (n=93) and female (n=79) athletes, 18 to 25 years of age, who participated in collision/contact sports, volunteered to complete the "concussion survey" following the standard PPE and physical examination. Main Outcome Measures: The ability to detect an athlete's concussion history was assessed via a "concussion survey" that was based on commonly recognized concussion signs and symptoms. Concussion signs and symptoms were further categorized via "factor analysis" into three groups: sensory/local (i.e., dizziness, ringing in the ears, headache, dazed, and vision problems); constitutional/diffuse (i.e., sleep, nausea, personality changes, returning to play, and decreased coordination); and cognitive (i.e., memory loss, concentration, loss of consciousness/blacked out, and fatigue). Categorized data from the concussion survey were compared with the two open ended questions from the PPE that addressed prior incidence of head injuries. Results: Results of the study revealed that 71% of the athletes responded to the concussion survey but not the PPE. This finding indicated that even though athletes experienced signs and/or symptoms of concussion, they did not realize that they may have sustained a concussion. Therefore reliance on the two questions from the PPE to identify concussed athletes appears to be unreliable. When examining the occurrence of varied concussion signs and symptoms, the most common symptom was headache, which accounted for 46 (56.1%) positive responses of the 82 athletes identified by both questionnaires. Further, the Cronbach's alpha indicated that the reliability of "factor analysis" was relatively high in factors one and two and moderate in factor three. Conclusions: Within the limitations of the present study, the concussion survey revealed a greater number of athletes that may have experienced at least one concussion or signs and symptoms of a head injury than the PPE. Therefore, the data from the present study support the recommendation that future PPEs should include signs and symptoms of concussion and not just the athletes' perceived incidence of head injury, and further that a combination of both the concussion survey and the PPE should be used for detection of head injury in collegiate athletes (1, 2, 3)