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Objective:  This study examined factor models for the Post-Concussion Symptom Scale (PCSS) at baseline and after suspected sport-related concussion, and measurement invariance from pre-injury to post-injury assessments and across age, gender, and health history groups (e.g., attention-deficit/hyperactivity disorder, psychiatric history).  Methods:  Adolescent student athletes (ages 13-18) completed a baseline PCSS ( n  = 39,015; 54.3% boys) and a subsample within 21 days of a suspected concussion ( n  = 1,554; 56.7% boys) completed a post-injury PCSS. Five models were evaluated for fit and invariance.  Results:  Confirmatory factor analyses showed good baseline and post-injury model fit for a previously supported four-factor model (i.e., cognitive-sensory, sleep-arousal, vestibular-somatic, and affective), an alternative four-factor model (i.e., cognitive, sleep-arousal, physical, and affective), and an incomplete bifactor model with vestibular-somatic and affective specific factors, along with partial invariance from pre-injury to post-injury assessments. Partial-to-full invariance was established for each model at baseline across demographic and health history groups.  Conclusions:  Results showed empirical and conceptual support for both PCSS subscales (i.e., cognitive, sleep-arousal, physical, and affective) and a total score for use in pre-injury to post-injury assessments and across demographic and health history groups at baseline. Future normative data, stratified by demographics and health history, could provide more precise symptom assessments for concussion management.

The structure of post-concussion symptoms in adolescent student athletes: Confirmatory factor analysis and measurement invariance