Examining Criteria for Defining Persistent Post-concussion Symptoms in Children and Adolescents

Grant L. Iverson, Justin E. Karr, Bruce Maxwell, Ross Zafonte, Paul D. Berkner, Nathan E. Cook

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. This cross-sectional study included a large sample (age range: 11–18) of girls (n = 21,923) and boys (n = 26,556) without a recent concussion who completed the Post-Concussion Symptom Scale at preseason baseline. Endorsements rates varied substantially by definition, health history, and current health issues. The most lenient definition (i.e., a single mild symptom) was endorsed by most participants (54.5% of boys/65.3% of girls). A large portion of participants with pre-existing mental health problems (42.7% of boys/51.5% of girls), current moderate psychological distress (70.9% of boys/72.4% of girls), and insufficient sleep prior to testing (33.4% of boys/47.6% of girls) endorsed symptoms consistent with mild ICD-10 postconcussional syndrome; whereas participants with no current or prior health problems rarely met this definition (1.6% of boys/1.6% of girls). The results illustrate the tremendous variability in the case definitions of persistent symptoms and the importance of harmonizing definitions across future studies.

Original languageEnglish
Article number614648
JournalFrontiers in Neurology
StatePublished - Feb 23 2021

Bibliographical note

Funding Information:
Funding. This work funded in part by the Goldfarb Center for Public Policy and Civic Engagement at Colby College, and the Bill and Joan Alfond Foundation (PI: PB). GI acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, Boston Bolts, Heinz Family Foundation, National Rugby League, and the Spaulding Research Institute. NC acknowledges support from the Louis V. Gerstner III Research Scholar Award. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.

Publisher Copyright:
© Copyright © 2021 Iverson, Karr, Maxwell, Zafonte, Berkner and Cook.


  • assessment
  • brain trauma
  • mild traumatic brain injury
  • outcome research
  • pediatrics
  • postconcussional syndrome
  • symptoms

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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