Objective:

To evaluate changes in post-concussion symptom clusters during recovery in athletes.

Background:

The Sport Concussion Assessment Tool (SCAT) Symptom Scale is widely used in concussion diagnosis and management. A previous study aggregated SCAT symptoms into five clusters: energy, mental health, migrainous, cognitive, and vestibular-ocular. We investigated changes in these symptom clusters during the recovery period.

Design/Methods:

Retrospective descriptive study in 439 patients (60.6% male; mean age 15.4 +3.1 years) evaluated for concussion within 14 days of injury at a specialized concussion clinic (September, 2016 – February, 2020). Symptom cluster severity (asymptomatic, mild, moderate, severe) and dominance (highest mean symptom score) were recorded from the immediate post-injury period (0 – 2 days) through post-injury week 4. 

Results:

Dominant symptom clusters were energy (40%) and migrainous (34%) during the immediate post-injury period, with 47% and 42% of patients reporting at least moderate energy and migrainous symptoms, respectively. Migrainous symptoms remained the most common and severe through four weeks. Cognitive cluster became the second most common by week three (24%). The severity of the energy and migrainous symptoms decreased over the post-injury period. Cognitive, mental health, and vestibular-ocular symptoms had a less pronounced reduction in severity into weeks 3 and 4.

Conclusions:

Post-concussion symptom clusters change in both dominance and severity over the recovery period. Migrainous and energy symptoms are greater during early recovery but improve over time. Cognitive, mental health, and vestibular-ocular symptoms do not improve as significantly in patients who are still symptomatic at weeks 3 and 4. Future research should investigate whether symptom clusters offer prognostic value.