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. 2026 Jan 28.
doi: 10.1249/MSS.0000000000003949. Online ahead of print.

Clinical Cut Point for the Post Concussion Symptom Inventory Following Adolescent Concussion

Catherine C Donahue  1   2 , Katherine L Smulligan  3 , Mathew J Wingerson  1   2 , Joshua R Kniss  1   2 , Julie C Wilson  1   2   4 , David R Howell  1   2
Affiliations

Clinical Cut Point for the Post Concussion Symptom Inventory Following Adolescent Concussion

Catherine C Donahue et al. Med Sci Sports Exerc. .

Abstract

Background: The Post Concussion Symptom Inventory (PCSI) evaluates the severity of 21 concussion-related symptoms, yielding a total symptom severity between 0-126. Although widely used in concussion research and care as a key element in diagnosis and management decisions, no clinically validated cut point exists to distinguish adolescents with and without a recent concussion. Therefor the purpose of our study was to establish a PCSI cut point with adequate sensitivity, specificity, and classification accuracy for clinical use.

Methods: Adolescents within 21 days of concussion and uninjured controls completed the PCSI, and total symptom severity score was calculated. We used independent samples t-tests to compare total PCSI symptom severity scores between groups, and multivariable logistic regression to calculate adjusted odds ratios (outcome=group, predictor=PCSI score, covariates=age, biological sex, concussion history, history of anxiety and/or depression). A receiver operator characteristic (ROC) curve was used to evaluate the area under the ROC curve (AUC) and determine the optimal cut point to distinguish between adolescents with/without a concussion.

Results: 153 adolescents with a concussion (15.4±1.6 years; 54% female; 8.2±3.6 days since injury), and 200 uninjured controls (15.8±1.1 years; 84% female) were included. The concussion group had significantly higher PCSI scores than the control group (47.4±26.8 vs. 20.9±19.4; p<0.001). The univariable AUC value for the PCSI to differentiate between groups was 0.80 (95% confidence interval [CI]=0.75,0.85), and correctly classified 74% of participants as concussion or control group using a PCSI cut point of 23 (sensitivity=68%, specificity=83%).

Conclusions: Our results suggest a PCSI cut point of 23 can distinguish between adolescents with/without a recent concussion and may provide enhanced accuracy to identify a suspected concussion in the subacute time after injury.

Keywords: ADOLESCENTS; CLINICAL THRESHOLD; SYMPTOM SEVERITY.

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Conflict of interest statement

Conflict of Interest and Funding Source: This study was funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (R01HD108133) the Tai Foundation, the Denver Broncos Foundation, and MINDSOURCE Brain Injury Network.

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