Primary and Secondary Risk Factors Associated With Concussion Symptom Clusters in Collegiate Athletes: Results From the NCAA-DoD Grand Alliance CARE Consortium

Kate E Nolan; Jaclyn B Caccese; Anthony P Kontos; Thomas A Buckley; Gian-Gabriel P Garcia; Nicholas Port; Steven P Broglio; Thomas W McAllister; Michael McCrea; Paul F Pasquina; Jasmeet P Hayes; CARE Consortium Investigators

doi:10.1177/23259671231163581

Primary and Secondary Risk Factors Associated With Concussion Symptom Clusters in Collegiate Athletes: Results From the NCAA-DoD Grand Alliance CARE Consortium

Orthop J Sports Med. 2023 Apr 13;11(4):23259671231163581. doi: 10.1177/23259671231163581. eCollection 2023 Apr.

Affiliations

¹ Department of Psychology, The Ohio State University, Columbus, Ohio, USA.
² College of Medicine, The Ohio State University, Columbus, Ohio, USA.
³ University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁴ University of Delaware, Newark, Delaware, USA.
⁵ Georgia Institute of Technology, Atlanta, Georgia, USA.
⁶ Indiana University, Bloomington, Indiana, USA.
⁷ Michigan Concussion Center, Ann Arbor, Michigan, USA.
⁸ School of Medicine, Indiana University, Indianapolis, Indiana, USA.
⁹ Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

Abstract

Background: There is a broad and diverse range of symptoms after a concussion, from irritability to nausea. This heterogeneity of symptoms is a challenge for clinicians managing the different presentations among injuries. Prior research has investigated the structure of postconcussive symptoms to determine if they can be grouped into clusters of related symptoms.

Purpose/hypothesis: The purpose of this study was to identify symptom clusters during the acute phase after a sports-related concussion using exploratory factor analysis and to understand the relationship between risk factors for postconcussion symptoms (ie, demographics, injury characteristics, mental health, and sleep qualities) and different symptom clusters. We hypothesized that certain factors would be predictive of specific symptom clusters.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Collegiate athletes (N = 1104) from the Concussion, Assessment, Research, and Education (CARE) Consortium completed the Sport Concussion Assessment Tool-Third Edition symptom assessment tool 24 to 48 hours after concussion. Exploratory factor analysis was conducted on the symptom evaluation to determine symptom clusters 24 to 48 hours after concussion. Regression analysis was used to examine the effects of pre- and postinjury characteristics.

Results: Exploratory factor analysis revealed a 4-cluster structure for acute postconcussive symptoms that explained 62% of the variance in symptom reporting: vestibular-cognitive, migrainous, cognitive fatigue, and affective. Delayed reporting, less sleep before assessment, female sex, and being hurt outside of competition (during practice/training) was correlated with increased symptoms for 4 symptom clusters. Depression predicted higher vestibular-cognitive and affective symptoms. Amnesia was correlated with higher vestibular-cognitive and migrainous symptoms, whereas migraine history was associated with more migrainous and affective symptoms.

Conclusion: Symptoms can be grouped into 1 of 4 distinct clusters. Certain variables were associated with increased symptoms across multiple clusters and may be indicative of greater injury severity. Other factors (ie, migraine history, depression, amnesia) were associated with a more specific symptom presentation and may be mechanistically related to concussion outcomes and biological markers.

Keywords: CARE Consortium; clinical assessment; concussion; factor analysis.