Clinical Cut Point For The Post Concussion Symptom Inventory Following Adolescent Concussion

PURPOSE: The Post Concussion Symptom Inventory (PCSI) evaluates the severity of 22 concussion-related symptoms from 0 “None” to 6 “Severe”, yielding a total symptom severity between 0-132. Widely used in concussion research and care as a key element in diagnosis, a cut point distinguishing those with and without a concussion has not been examined. Our purpose was to determine the diagnostic utility of the PCSI for adolescents with a recent concussion by establishing a PCSI clinical cut point to distinguish between adolescents with and without concussion. METHODS: We enrolled and evaluated adolescents within 14 days of concussion and uninjured controls. Participants rated symptom severity using the PCSI. Independent t-tests were performed to compare PCSI scores between groups. We evaluated the area under the receiver operator curve (ROC) to determine the optimal cutoff score to distinguish between adolescents with/without a concussion. RESULTS: 153 adolescents with a concussion (15.4 ± 1.6 years; 54% female; 8.2 ± 3.6 days since injury), and 200 uninjured controls (15.8 ± 1.1 years; 84% female) were included. The concussion group had significantly higher PCSI scores than the control group (47.4 ± 26.8 vs. 20.9 ± 19.4; p < 0.001). The PCSI AUC was 0.80 (95% confidence interval [CI] = 0.75,0.85). After controlling for age, sex, concussion history, and history of anxiety and/or depression, the multivariable model AUC was 0.88 (95%CI = 0.84,0.91)(Figure 1.). The model correctly classified 74% of participants as concussion or control using a PCSI cut point of 23 (sensitivity = 68%, specificity = 83%). CONCLUSION: Our results suggest a PCSI cutoff score of 23 can distinguish between adolescents with/without a recent concussion. Using a cut point of 23 may provide enhanced accuracy to identify a suspected concussion in the first 14 days after injury and, in the absence of baseline data, guide clinical care.