© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com. doi:10.1093/arclin/acz061 Advance Access publication 26 November 2019 Archives of Clinical Neuropsychology 36 (2021) 430–436 Utility of Brief Psychological Measures for Prediction of Prolonged Symptom Clearance in Concussed Student Athletes Kristin Wilmoth 1 , Nicholas Curcio 2 , Tahnae Tarkenton 2 , Tawny Meredith-Duliba 2 , Alexander Tan 3 , Nyaz Didehbani 2 , Linda S. Hynan 2,4 , Shane M. Miller 5 , Kathleen R. Bell 6 and C. Munro Cullum 2,7, * 1 Departments of Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA 2 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA 3 Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA 4 Department of Population and Data Sciences (Biostatistics), University of Texas Southwestern Medical Center, Dallas, TX, USA 5 Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern Medical Center and Department of Sports Medicine, Texas Scottish Rite Hospital for Children, Dallas, TX, USA 6 Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA 7 Departments of Neurology & Neurotherapeutics and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA *Corresponding author at: 5323 Harry Hines Blvd. Dallas, TX 75390-9044, USA. Tel.: (214) 648-5277; fax: (214) 648-5297. E-mail address: Munro.Cullum@UTSouthwestern.edu (C. M. Cullum) Editorial Decision 26 September 2019 Accepted 5 October 2019 Abstract Objective: Variability in recovery time following sport-related concussion (SRC) is poorly understood. We explored the utility of brief mood, anxiety, and sleep questionnaires as postinjury predictors of SRC symptom clearance in adolescents. Method: At initial visit 0–2 weeks postinjury, concussed athletes aged 12–18 years self-reported injury/medical factors (prior concussion, loss of consciousness, amnesia, and concussion symptom severity) and were administered psychological symptom measures. At 3 months, medical record review determined return-to-play (RTP) date. Subjects were divided into two datasets, with the first utilized for developing cutoff scores and then validated with the second dataset. Results: A total of 64% of the 141 participants had early RTP (within 21 days postinjury), and 23% had late RTP (postinjury day 30 or later). The Generalized Anxiety Disorder Screener (GAD-7, M = 2.1, SD = 3.1) was the only significant predictor (p = .001), with a 1.4-fold [95% CI 1.2–1.8] increased risk for every point. No other factors in the full model discriminated recovery groups (ps > .05). Receiver operating characteristic curve analysis derived a GAD-7 cut score ≥3 (sensitivity= 56.7%, specificity = 74.2%, AUCs = 0.63–0.79, ps < .001). Conclusions: Postconcussion anxiety symptoms may help identify individuals at increased risk for prolonged recovery. Keywords: Concussion; Athletes; Sports; Adolescent psychology; Psychological screening inventory; Neuropsychological rehabilitation Introduction Recent figures estimate nearly 2 million pediatric sports- and recreation-related traumatic brain injuries occur annually within the United States (Bryan et al., 2016), though this is likely an underestimate due to misdiagnosed or untreated injuries. Sport- related concussions (SRCs) comprise roughly 9% of high school sport-related injuries (Gessel et al., 2007). Identifying protective and risk factors associated with outcomes is important, as lingering concussion symptoms can negatively impact adolescents’ academic, social, and emotional functioning (McCrory et al., 2017). Continued exploration of various medical and psychosocial risk factors for prolonged recovery from SRC may aid in the identification of these individuals and assist in tailoring effective concussion interventions. Downloaded from https://academic.oup.com/acn/article/36/3/430/5640307 by guest on 12 June 2022