Connecting the Dots: Network Analysis of the Concussion Clinical Profiles Screening among Adolescents.

Abstract

To examine the network structure and relationships between common postconcussion symptoms and to apply network analysis techniques to the Concussion Clinical Profiles Screening (CP Screen) in order to determine whether the CP Screen items cluster together within the appropriate predefined profiles. Participants included 913 adolescents (mean age = 15.04 ± 1.60 years, 43.3% female) seen in a specialty clinic within 7.04 ± 18.54 days of a diagnosed concussion. Participants completed the 29-item CP Screen at their initial clinic visit, which were used to estimate networks and calculate centrality (strength, betweenness, expected influence) and bridge strength. Network stability was assessed via bootstrapped case-dropping procedures (1000 iterations). The most central symptoms were slow/wavy dizziness (vestibular; strength z score = 1.90), headache with cognitive exertion (cognitive/fatigue; strength z score = 1.50), eye strain (ocular; strength z score = 1.40), headache with light and noise (post-traumatic migraine; strength z score = 1.18), hyposomnia (sleep; strength z score = 1.02), and feeling more stressed than usual (mood/anxiety; strength z score = 0.89). Bridge analysis identified headache with cognitive exertion, difficulty in busy environments, post-traumatic migraine-related symptoms, and ocular-motor symptoms as key connectors across symptom clusters. Network stability was excellent (edge-weight correlation stability coefficient = 0.75; strength correlation stability coefficient = 0.67). Community analysis identified 4 communities: anxiety/mood, vestibular, ocular, and headache/migraine. Modularity was modest but indicative of meaningful community structure, and there was moderate agreement with the pre-defined clinical profiles. Network analysis supported the CP Screen's original clinical profile structure. Findings also identified key central symptoms that may be driving elevated symptom burden postconcussion, as well as those symptoms that connect across profiles. This symptom profile approach may inform more effective, and targeted interventions for adolescents following concussion.