Psychometric evaluation and reference values for the German Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years

Marina Zeldovich; Leonie Krol; Dagmar Timmermann; Ugne Krenz; Juan Carlos Arango-Lasprilla; Gerard Gioia; Knut Brockmann; Inga K Koerte; Anna Buchheim; Maike Roediger; Matthias Kieslich; Nicole von Steinbuechel; Katrin Cunitz

doi:10.3389/fneur.2023.1266828

Psychometric evaluation and reference values for the German Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years

Front Neurol. 2023 Nov 17:14:1266828. doi: 10.3389/fneur.2023.1266828. eCollection 2023.

Authors

Affiliations

¹ Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany.
² Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
³ Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States.
⁴ Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery and Education Program, Children's National Health System, Department of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Rockville, MA, United States.
⁵ Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Goettingen, Germany.
⁶ Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.
⁷ Department of Pediatric and Adolescent Medicine- General Pediatrics- Intensive Care Medicine and Neonatology, University Hospital Muenster, Muenster, Germany.
⁸ Department of Paediatric Neurology, Goethe-University Frankfurt/Main, Frankfurt, Germany.
⁹ Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.

Abstract

Background: Post-concussion symptoms (PCS) are a common consequence of pediatric traumatic brain injury (pTBI). They include cognitive, emotional, and physical disturbances. To address the lack of age-adapted instruments assessing PCS after pTBI, this study examines the psychometric properties of the German 17-item post-TBI version of the Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years. The study also aims to establish reference values based on data from a pediatric general population sample to better estimate the prevalence and clinical relevance of PCS after pTBI in clinical and research settings.

Methods: A total of 132 children aged 8-12 years from a post-acute TBI sample and 1,047 from a general population sample were included in the analyses. The questionnaire was translated from English into German and linguistically validated using forward and backward translation and cognitive debriefing to ensure comprehensibility of the developed version. Reliability and validity were examined; descriptive comparisons were made with the results of the English study. Measurement invariance (MI) analyses between TBI and general population samples were conducted prior to establishing reference values. Factors contributing to the total and scale scores of the PCSI-SR8 were identified using regression analyses. Reference values were calculated using percentiles.

Results: Most children (TBI: 83%; general population: 79%) rated at least one symptom as "a little" bothersome. The German PCSI-SR8 met the psychometric assumptions in both samples and was comparable to the English version. The four-factor structure comprising physical, emotional, cognitive, and fatigue symptoms could be replicated. The MI assumption was retained. Therefore, reference values could be provided to determine the symptom burden of patients in relation to a comparable general population. Clinical relevance of reported symptoms is indicated by a score of 8, which is one standard deviation above the mean of the general population sample.

Conclusion: The German version of the PCSI-SR8 is suitable for assessment of PCS after pTBI. The reference values allow for a more comprehensive evaluation of PCS following pTBI. Future research should focus on validation of the PCSI-SR8 in more acute phases of TBI, psychometric examination of the pre-post version, and child-proxy comparisons.

Keywords: Postconcussion Symptom Inventory (PCSI); patient-reported outcome measure (PROM); pediatric traumatic brain injury; post-concussion symptoms; reference values.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The TBI sample research (principal investigator: NS) was funded by Dr. Senckenbergische Stiftung/Clementine Kinderhospital Dr. Christ’sche Stiftungen (Germany) and Uniscientia Stiftung (Switzerland). The general population sample research (principal investigator: MZ) was funded by Dr. Senckenbergische Stiftung/Clementine Kinderhospital Dr. Christ’sche Stiftungen (Germany). The authors acknowledge support by the Open Access Publication Funds of the Göttingen University. The authors declare that the funders had no role in the preparation of the manuscript or in the analysis of the data presented in this study.