546 EP013 – Examining the Temporal Symptom Burden Acutely Following Concussion in Collegiate Athletes

Background The Sport Concussion Assessment Tool (SCAT) is the most widely used tool following sport-related concussion (SRC) and yields strong sensitivity and specificity. Initial SCAT symptom burden is reportedly the strongest predictor of recovery in collegiate athletes, however; it is unknown if symptom presentation varies within the acute (<48 hours) post-SRC phase. Objective Examine acute SRC symptom presentation among National Collegiate Athletic Association (NCAA) athletes. Design Prospective cohort. Setting Thirty universities across the United States that participated in the Concussion Assessment, Research, and Education (CARE) Consortium. Participants Concussed NCAA varsity-athletes (n=1,780) that were administered the SCAT at least once acutely post-SRC. Assessment-of-Risk-Factors Each participating site used a standardized clinical examination within the acute phase. Time of injury occurrence and SCAT administration were recorded, from which time-to-SCAT was calculated. Main Outcomes The main outcome, SCAT symptom evaluation, is a standardized 22-item list with a 0–6 Likert scale for each symptom (higher score=greater burden), from which total symptom severity (TSS; 0–132) is calculated. Multivariable negative binomial regression was used to examine the association between time (hours) since injury and initial (i.e., first assessment) TSS. Covariates included sex, previous concussion, sport contact level, amnesia/loss of consciousness, injury situation, and number of evaluations <48 hrs. TSS score ratios (SR) with associated 95% confidence intervals (CI) were provided, with 95% CI not including 1.00 considered statistically significant. Results The SCAT was administered an average of 14 (IQR:1.2–24) hours post-SRC, and average TSS was 29.3±21.5 across all participants. Time-to-SCAT was not associated with TSS after adjusting for covariate effects (SR:1.00, 95% CI:1.00–1.00). Conclusions Time-to-SCAT did not significantly associate with TSS within the acute timeframe of SRC recovery. The inherent variability between athletes in self-reporting symptom type and severity may be important considerations. Future research should consider a within-subject study design and analysis of TSS to better understand the temporal trajectories of symptoms experienced after SRC.