Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Sample Characteristics
3.2. RQ #1: Concussion Symptoms Reported via Free-Response Item
3.3. RQ #2: Differences in Concussion Symptoms Reported via Free-Response Item versus Scale Measure
3.4. Exploratory RQ #3: Differences in Concussion Symptoms Reported via Free-Response Item by Sample Characteristics
4. Discussion
4.1. Concussion Symptoms Identified by Free-Response Item
4.2. Differences of Concussion Symptom Knowledge by Sample Characteristics
4.3. Comparisons between Concussion Symptom Free-Response Item and Scale Measure
4.4. Methodological Implications
4.5. Clinical Implications
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Sample Characteristics | n | % |
---|---|---|
Sex | ||
Male | 364 | 34.3 |
Female | 698 | 65.7 |
Age (in years) | ||
Under 30 | 96 | 9.0 |
30–39 | 416 | 39.2 |
40–49 | 346 | 32.6 |
50 and over | 204 | 19.2 |
Race/ethnicity | ||
White/non-Hispanic | 626 | 58.9 |
Other racial/ethnic group | 436 | 41.1 |
Hispanic/Latino | 165 | 15.5 |
Black/African-American | 140 | 13.2 |
Asian/Pacific-Islander | 78 | 7.3 |
Mixed race/other | 53 | 5.0 |
Highest level of education completed | ||
Less than bachelor’s degree | 588 | 55.4 |
Less than high school | 12 | 1.1 |
High school or GED | 210 | 19.8 |
Some college, no degree | 218 | 20.5 |
Associate’s degree | 148 | 13.9 |
Bachelor’s degree or more | 474 | 44.6 |
Bachelor’s degree | 313 | 29.5 |
Master’s degree | 108 | 10.2 |
Doctorate | 24 | 2.3 |
Professional degree | 29 | 2.7 |
Personal and child concussion history | ||
Neither | 694 | 65.3 |
Personal history only | 229 | 21.6 |
Child history only | 68 | 6.4 |
Both personal and child history | 71 | 6.7 |
MS child played organized sports within past year | ||
No | 274 | 25.8 |
Yes | 788 | 74.2 |
Symptom Category and Symptoms | Participants, n (%) | Symptom Category and Symptoms | Participants, n (%) |
---|---|---|---|
Somatic | Vestibular-ocular | ||
Headache 2 | 526 (49.5) | Dizziness 2 | 472 (44.4) |
Nausea or vomiting 2 | 297 (28.0) | Blurred vision 2 | 175 (16.5) |
Sensitivity to light 2 | 34 (3.2) | Eyes/pupils do not look right | 104 (9.8) |
Bump on head | 15 (1.4) | Balance problems 2 | 37 (3.5) |
Head/brain swelling | 10 (0.9) | Hearing changes | 31 (2.9) |
Neck pain 2 | 7 (0.7) | Cannot walk, get up, stand properly | 16 (1.5) |
Hard to breathe | 6 (0.6) | See weird things | 15 (1.4) |
Chills and sweating | 5 (0.5) | Not coordinated | 14 (1.3) |
Bruise on head | 5 (0.5) | Shaky or wobbly | 9 (0.8) |
“Pressure in the head” 2 | 4 (0.4) | Motor issues | 7 (0.7) |
Sensitivity to noise 2 | 4 (0.4) | Blinking a lot | 1 (0.1) |
Numbness | 4 (0.4) | Ear pain | 1 (0.1) |
Change in appetite | 4 (0.4) | Sleep | |
Seizure | 4 (0.4) | Fatigue or low energy 2 | 151 (14.2) |
Death | 3 (0.3) | Feel sleepy | 98 (9.2) |
Change in heart rate | 2 (0.2) | Drowsiness 2 | 31 (2.9) |
Cognitive | Sleep disruptions | 7 (0.7) | |
Confusion 2 | 229 (21.6) | Trouble waking up | 4 (0.4) |
Difficulty remembering 2 | 149 (14.0) | Sleep too much | 4 (0.4) |
Loss of consciousness | 149 (14.0) | Restless | 4 (0.4) |
Difficulty speaking | 96 (9.0) | Sleep too little | 2 (0.2) |
Disoriented | 66 (6.2) | Emotional | |
“Glazed over” look | 33 (3.1) | Irritability 2 | 7 (0.7) |
Not focused/scattered thoughts | 26 (2.4) | Aggression/angered | 7 (0.7) |
Incoherent | 14 (1.3) | Mood swings | 7 (0.7) |
Feeling like “in a fog” 2 | 12 (1.1) | Nervous or anxious 2 | 5 (0.5) |
Feeling slowed down 2 | 12 (1.1) | Sadness 2 | 5 (0.5) |
Difficulty concentrating 2 | 11 (1.0) | Erratic behavior | 3 (0.3) |
“Don’t feel right” 2 | 7 (0.7) | Delirious | 2 (0.2) |
Acting funny or different | 6 (0.6) | Mental status change | 1 (0.1) |
Behavior change | 4 (0.4) | More lively | 1 (0.1) |
Don’t recognize things | 3 (0.3) | Stressed out | 1 (0.1) |
Cannot do/lost interest in normal tasks | 3 (0.3) | Want to hurt self | 1 (0.1) |
Cognitive change | 3 (0.3) | Feel lost | 1 (0.1) |
Trouble understanding things | 2 (0.2) | State of shock | 1 (0.1) |
Trouble learning things | 1 (0.1) | Make poor judgment | 1 (0.1) |
Repeating same things | 1 (0.1) |
Symptoms | Identified on Free-Response Item 1, n (%) | Identified “Yes” on Scale Measure 2, n (%) | Counts of Symptoms per Measure | McNemar Odds Ratio (95% CI) 3 | |||
---|---|---|---|---|---|---|---|
Both | Free-Response Item Only | Scale Measure Only | Neither | ||||
Headache | 526 (49.5) | 877 (82.6) | 481 | 45 | 396 | 140 | 0.11 (0.08, 0.15) * |
Dizziness | 472 (44.4) | 958 (90.2) | 450 | 22 | 508 | 82 | 0.04 (0.03, 0.07) * |
Nausea or vomiting | 297 (28.0) | 833 (78.4) | 282 | 15 | 551 | 214 | 0.03 (0.02, 0.05) * |
Confusion | 229 (21.6) | 905 (85.2) | 214 | 15 | 691 | 142 | 0.02 (0.01, 0.04) * |
Blurred vision | 175 (16.5) | 928 (87.4) | 168 | 7 | 760 | 127 | 0.009 (0.004, 0.02) * |
Fatigue or low energy | 151 (14.2) | 655 (61.7) | 131 | 20 | 524 | 387 | 0.04 (0.02, 0.06) * |
Difficulty remembering | 149 (14.0) | 861 (81.1) | 134 | 15 | 727 | 186 | 0.02 (0.01, 0.03) * |
Balance problems | 37 (3.5) | 917 (86.4) | 34 | 3 | 883 | 142 | 0.003 (0.001, 0.01) * |
Sensitivity to light | 34 (3.2) | 698 (65.7) | 32 | 2 | 666 | 362 | 0.003 (0.001, 0.01) * |
Drowsiness | 31 (2.9) | 803 (75.6) | 26 | 5 | 777 | 254 | 0.006 (0.003, 0.02) * |
Feeling like “in a fog” | 12 (1.1) | 811 (76.4) | 10 | 2 | 801 | 249 | 0.003 (0.001, 0.01) * |
Feeling slowed down | 12 (1.1) | 675 (63.6) | 9 | 3 | 666 | 384 | 0.005 (0.001, 0.01) * |
Difficulty concentrating | 11 (1.0) | 845 (79.6) | 8 | 3 | 837 | 214 | 0.004 (0.01, 0.01) * |
“Don’t feel right” | 7 (0.7) | 805 (75.8) | 5 | 2 | 800 | 255 | 0.003 (0.001, 0.01) * |
Neck pain | 7 (0.7) | 654 (61.6) | 7 | 0 | 647 | 408 | N/A |
Irritability | 7 (0.7) | 464 (43.7) | 4 | 3 | 460 | 595 | 0.007 (0.002, 0.02) * |
Nervous or anxious | 5 (0.5) | 295 (27.8) | 2 | 3 | 374 | 683 | 0.008 (0.003, 0.03) * |
Sadness | 5 (0.5) | 376 (35.4) | 1 | 4 | 294 | 763 | 0.01 (0.005, 0.04) * |
Sensitivity to noise | 4 (0.4) | 577 (54.3) | 3 | 1 | 574 | 484 | 0.002 (0.001, 0.01) * |
“Pressure in the head” | 4 (0.4) | 808 (76.1) | 1 | 3 | 807 | 251 | 0.004 (0.001, 0.01) * |
Trouble falling asleep | 0 | 387 (36.4) | 0 | 0 | 387 | 675 | N/A |
More emotional | 0 | 365 (34.4) | 0 | 0 | 365 | 697 | N/A |
Symptom Reported | n | Sex | Age (in Years) | ||||
---|---|---|---|---|---|---|---|
Male | Female | p-Value | <40 | ≥40 | p-Value | ||
Headache | 526 | 166 (45.6) | 360 (51.6) | 0.06 | 224 (43.8) | 302 (54.9) | <0.001 * |
Dizziness | 472 | 155 (42.6) | 317 (45.4) | 0.38 | 203 (39.6) | 269 (48.9) | 0.002 * |
Nausea or vomiting | 297 | 74 (20.3) | 223 (31.9) | <0.001 * | 130 (25.4) | 167 (30.4) | 0.07 |
Confusion | 229 | 70 (19.2) | 159 (22.8) | 0.18 | 113 (22.1) | 116 (21.1) | 0.70 |
Blurred vision | 175 | 55 (15.1) | 120 (17.2) | 0.39 | 73 (14.3) | 102 (18.5) | 0.06 |
Fatigue or low energy | 151 | 31 (8.5) | 120 (17.2) | <0.001 * | 71 (13.9) | 80 (14.5) | 0.75 |
Difficulty remembering | 149 | 67 (18.4) | 82 (11.7) | 0.003 * | 77 (15.0) | 72 (13.1) | 0.36 |
Loss of consciousness | 149 | 49 (13.5) | 100 (14.3) | 0.70 | 76 (14.8) | 73 (13.3) | 0.46 |
Eyes/pupils do not look right | 104 | 24 (6.6) | 80 (11.5) | 0.01 * | 34 (6.6) | 70 (12.7) | <0.001 * |
Feel sleepy | 98 | 17 (4.7) | 81 (11.6) | <0.001 * | 42 (8.2) | 56 (10.2) | 0.27 |
Symptom Reported | n | Race/Ethnicity (Identified as White/Non-Hispanic) | Highest Level of Education Completed (Bachelor’s Degree or More) | ||||
Yes | No | p-Value | Yes | No | p-Value | ||
Headache | 526 | 331 (52.9) | 195 (44.7) | 0.009 * | 236 (49.8) | 290 (49.3) | 0.88 |
Dizziness | 472 | 281 (44.9) | 191 (43.8) | 0.73 | 214 (45.1) | 258 (43.9) | 0.68 |
Nausea or vomiting | 297 | 209 (33.4) | 88 (20.2) | <0.001 * | 134 (28.3) | 163 (27.7) | 0.84 |
Confusion | 229 | 155 (24.8) | 74 (17.0) | 0.002 * | 111 (23.4) | 118 (20.1) | 0.19 |
Blurred vision | 175 | 123 (19.6) | 52 (11.9) | <0.001 * | 76 (16.0) | 99 (16.8) | 0.73 |
Fatigue or low energy | 151 | 96 (15.3) | 55 (12.6) | 0.21 | 74 (15.6) | 77 (13.1) | 0.24 |
Difficulty remembering | 149 | 77 (12.3) | 72 (16.5) | 0.052 | 78 (16.5) | 71 (12.1) | 0.04 * |
Loss of consciousness | 149 | 82 (13.1) | 67 (15.4) | 0.30 | 72 (15.2) | 77 (13.1) | 0.33 |
Eyes/pupils do not look right | 104 | 80 (12.8) | 24 (5.5) | <0.001 * | 45 (9.5) | 59 (10.0) | 0.77 |
Feel sleepy | 98 | 65 (10.4) | 33 (7.6) | 0.12 | 29 (6.1) | 69 (11.7) | 0.002 * |
Symptom Reported | n | Parent or MS Child Reported Concussion History | MS Child Played Organized Sports within Past Year | ||||
Yes | No | p-Value | Yes | No | p-Value | ||
Headache | 526 | 180 (48.9) | 346 (49.9) | 0.77 | 393 (49.9) | 133 (48.5) | 0.70 |
Dizziness | 472 | 158 (42.9) | 314 (45.2) | 0.47 | 363 (46.1) | 109 (39.8) | 0.07 |
Nausea or vomiting | 297 | 111 (30.2) | 186 (26.8) | 0.25 | 223 (28.3) | 74 (27.0) | 0.68 |
Confusion | 229 | 84 (22.8) | 145 (20.9) | 0.47 | 179 (22.7) | 50 (18.2) | 0.12 |
Blurred vision | 175 | 67 (18.2) | 108 (15.6) | 0.27 | 129 (16.4) | 46 (16.8) | 0.87 |
Fatigue or low energy | 151 | 62 (16.8) | 89 (12.8) | 0.07 | 112 (14.2) | 39 (14.2) | 0.99 |
Difficulty remembering | 149 | 48 (13.0) | 101 (14.6) | 0.50 | 119 (15.1) | 30 (10.9) | 0.09 |
Loss of consciousness | 149 | 54 (14.7) | 95 (13.7) | 0.66 | 110 (14) | 39 (14.2) | 0.91 |
Eyes/pupils do not look right | 104 | 43 (11.7) | 61 (8.8) | 0.13 | 78 (9.9) | 26 (9.5) | 0.84 |
Feel sleepy | 98 | 33 (9.0) | 65 (9.4) | 0.83 | 98 (9.2) | 71 (9.0) | 0.68 |
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Kerr, Z.Y.; Ingram, B.M.; Callahan, C.E.; Nedimyer, A.K.; Chandran, A.; Kossman, M.K.; Hoang, J.; Gildner, P.; Register-Mihalik, J.K. Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children. Int. J. Environ. Res. Public Health 2021, 18, 12070. https://doi.org/10.3390/ijerph182212070
Kerr ZY, Ingram BM, Callahan CE, Nedimyer AK, Chandran A, Kossman MK, Hoang J, Gildner P, Register-Mihalik JK. Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children. International Journal of Environmental Research and Public Health. 2021; 18(22):12070. https://doi.org/10.3390/ijerph182212070
Chicago/Turabian StyleKerr, Zachary Y., Brittany M. Ingram, Christine E. Callahan, Aliza K. Nedimyer, Avinash Chandran, Melissa K. Kossman, Julia Hoang, Paula Gildner, and Johna K. Register-Mihalik. 2021. "Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children" International Journal of Environmental Research and Public Health 18, no. 22: 12070. https://doi.org/10.3390/ijerph182212070
APA StyleKerr, Z. Y., Ingram, B. M., Callahan, C. E., Nedimyer, A. K., Chandran, A., Kossman, M. K., Hoang, J., Gildner, P., & Register-Mihalik, J. K. (2021). Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children. International Journal of Environmental Research and Public Health, 18(22), 12070. https://doi.org/10.3390/ijerph182212070