Concussion-Symptom Rating Correlation Between Pediatric Patients and Their Parents

Context: Understanding how parents and their children perceive concussion symptoms may provide insights into optimal concussion-management strategies. Objective: To examine patient-parent correlations and agreement on concussion-symptom ratings, to identify differences in patient-parent symptom reporting between children (8-12 years of age) and adolescents (13-18 years of age), and to evaluate the correlation between patient and parent initial symptom-severity ratings with symptom duration and return-to-play time. Design: Cross-sectional study. Setting: Primary care sports medicine clinic. Patients or Other Participants: A total of 267 patients aged 8 to 18 years seen for care within 21 days of sustaining a concussion. Patients were classified as children (n = 65; age = 11.3 +/- 1.4 years; age range, 8-12 years) or adolescents (n = 202; age = 15.5 +/- 1.4 years; age range, 13-18 years). Main Outcome Measure(s): Each patient and his or her parent (or legal guardian) completed a concussion-symptom-frequency inventory, the Health and Behavior Inventory (HBI), at the initial postinjury examination. Patients were followed until they no longer reported concussion symptoms (symptom-resolution time) and were allowed to return to unrestricted sport participation (return-to-play time). Results: At the initial examination (8.9 +/- 5.2 days postinjury), the symptom-frequency correlation between children and their parents was high (r(s) = 0.88; 95% confidence interval [CI] = 0.80, 0.95). Adolescents' symptom-frequency reports were also highly correlated with those of their parents (r(s) = 0.78; 95% CI = 0.71, 0.85). However, the child-parent correlation was higher than the adolescent-parent agreement (z = 2.21, P =.03). Greater patient (consolidated child and adolescent) HBI ratings were associated with longer symptom-resolution times (coefficient = 0.019; 95% CI = 0.007, 0.031; P =.002) and longer return-to-play times (coefficient = 0.012; 95% CI = 0.002, 0.022; P =.02), whereas parent HBI ratings were not. Conclusions: Our findings may help to set expectations regarding concussion-symptom durations and return-to-play timing for pediatric patients and their families. Given the patient-parent correlations in our sample, substantial reporting discrepancies between patients and their parents may be a relevant factor for clinicians to investigate further during concussion evaluations.