Predictors of Persisting Concussion Symptoms Identified Among Adolescent Girls

Adolescent girls who report greater emotional symptoms following concussion are more likely to experience persisting concussion symptoms, according to study results published in Journal of Head Trauma Rehabilitation.

Adolescent girls are more vulnerable to concussions and experience greater symptom severity than boys, yet males are often overrepresented in concussion studies. To address this gap, researchers examined factors predicting persisting concussion symptoms in girls aged 12 to 18 years who were evaluated within 30 days of a clinically diagnosed concussion through the North Texas Concussion Registry between September 2015 and August 2024.

Participants completed the Symptom Evaluation from the Sport Concussion Assessment Tool-5 (SCAT5) as well as the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Pittsburgh Sleep Quality Index (PSQI) at the initial and 3-month follow-up visits.

Clinicians have easy access to the screening tools used in this study, which identify these predictors and may be included in initial evaluations in an evidence-based assessment of injury…

The analysis included 732 adolescent girls (mean age 14.8 years, 80.1% White). Most injuries (69.9%) were sport-related, and 37.5% required an emergency department visit. At 3 months, 44% of participants (n=325) reported persisting symptoms.

Clinical measures, including SCAT5 total and emotional cluster scores, GAD-7, PHQ-8, and PSQI, were significantly higher among those with persisting symptoms at both time points (all P < .001). The most common ongoing symptoms were difficulty concentrating (63.7%), difficulty remembering (56.6%), trouble falling asleep (52.3%), irritability (52.0%), and pressure in the head (45.2%).

Machine-learning and logistic-regression models both effectively predicted persisting symptoms. The random forest model achieved an area under the curve (AUC) of 0.73, slightly outperforming logistic regression (AUC, 0.70). Top predictors included GAD-7 score, SCAT5 total symptom severity, PHQ-8 score, PSQI score, SCAT5 emotional cluster severity, time from injury to evaluation, headache or migraine history, BMI, and age.

Study limitations include the use of self-report measures, lack of pre-injury baseline data, and potential variation in post-injury care.

“Clinicians have easy access to the screening tools used in this study, which identify these predictors and may be included in initial evaluations in an evidence-based assessment of injury that may identify endophenotypes of concussion, especially those with an emotional component,” the researchers concluded.