The Symptom Checklist: The Most Overlooked Component of Your Baseline

The 22-item Post-Concussion Symptom Scale (PCSS), embedded in both the SCAT6 and ImPACT, is often treated as a formality during baseline testing — a quick form to fill out before the “real” testing begins. This is a mistake. The symptom checklist may be the single most important piece of your baseline for accurate post-injury clinical decision-making.

What the research shows

Research published in the Journal of Neurotrauma found that up to 40% of healthy, non-concussed athletes report at least one concussion-like symptom at baseline. Among youth athletes, a study by Schneider et al. (2017) published in PMC found that figure climbs to 67%. The most commonly endorsed baseline symptoms include fatigue (“I feel tired”), difficulty concentrating, nervousness or anxiety, trouble falling asleep, and headache.

These aren’t signs of injury. They’re normal human experiences — especially for teenagers managing academic stress, social pressure, early practice schedules, and chronic sleep deprivation. See also our deep dive on healthy athletes’ baseline symptoms.

Why personal baselines matter

Without knowing that a specific athlete normally reports a “3 out of 6” for fatigue and a “2 out of 6” for difficulty concentrating, a clinician evaluating the same athlete after a concussion might attribute those exact symptoms to the injury — leading to unnecessarily prolonged treatment or activity restriction.

Conversely, an athlete whose baseline symptom score is zero across all 22 items and who reports even modest symptom elevations after a head injury may warrant more clinical attention than the raw numbers suggest — because any elevation represents a departure from their personal norm.

Common confounders

Common confounders that inflate baseline symptom reports include: testing immediately after exertion, testing during exam week or high academic stress periods, testing when the athlete is ill or hasn’t slept well, menstrual cycle-related symptoms (headache, fatigue, irritability), seasonal allergies, and test-taking anxiety. Administering the symptom checklist under standardized conditions — rested, healthy, and calm — produces the most reliable baseline.

How we approach the symptom checklist

At Headquarters, we administer the symptom checklist with the same clinical rigor as our cognitive and balance assessments. We document the context (sleep quality the night before, recent exercise, current stressors) alongside the scores. Because the goal isn’t just to check a box — it’s to build a clinically useful profile of what “normal” feels like for this specific person.

Frequently asked questions