Abstract
Purpose :
We aim to understand which CISS items are most frequently reported and if symptom reporting is impacted by age, sex, time since concussion and survey method.
Methods :
Retrospective chart review was conducted to identify concussion patients from July 2014 to December 2020 through a multidisciplinary concussion clinic (MDCC) or a direct referral (REF) for evaluation. Patients either self-reported symptoms on the CISS using an iPad (MDCC) or responded verbally to the clinician administered CISS (REF). All individuals met inclusion criteria of < 18 years of age, < 1 year since concussion (sub-acute: 15-120 days, chronic: 121-365 days), 20/30 best-corrected visual acuity, and no ocular disease, strabismus or amblyopia. Age, sex, time since concussion, and CISS scores (15 items: 3 vision-related (CISS-V), 6 somatic (CISS-S), 6 cognitive (CISS-C)) were analyzed. Cronback’s analysis was used to assess CISS-subscale inter-item consistency and analysis of covariance (ANCOVA) was used to understand group differences in CISS scores.
Results :
Chart review identified 205 eligible patients (mean age 15 years ± 2.1; 141 female, 112 chronic, 105 MDCC). The mean CISS score (n= 205) was 27.80 ± 12.73. The most commonly reported symptoms were headaches (61% of patients reporting often or always), tired eyes (54%), losing concentration (52%), trouble remembering (44%) and uncomfortable eyes (44%). This trend was maintained across sex, time since concussion, and clinic type. Cronback’s alpha was 0.70, 0.83, 0.86 for CISS-V, C and S, respectively, indicating excellent inter-item consistency. The highest mean subscale score was for CISS-S (2.05±1.2) followed by CISS-C (1.96±0.98) and CISS-V (1.24±0.98). ANCOVA indicated age was a significant covariate (p <0.01). Higher scores were reported from the MDCC clinic (difference = 7.91; 95% CI: 4.22 – 11.61, p<0.001) and from sub-acute than chronic phase of concussion recovery (difference = 4.37; 95% CI: 0.68 – 8.06, p =0.02).
Conclusions :
Concussion patients most commonly reported somatic symptoms, such as headaches, tired and uncomfortable eyes. Patients who self-reported symptoms had higher symptoms scores, though symptoms reported were similar to clinician-administered. Clinicians administering the CISS may introduce a positive bias that lowers reported symptom intensity in post-concussion adolescents.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.