Acute Sport Concussion Assessment Optimization: A Prospective Assessment from the CARE Consortium. Sports Med 2019 Dec;49(12):1977-1987
Date
07/28/2019Pubmed ID
31347086DOI
10.1007/s40279-019-01155-0Scopus ID
2-s2.0-85069646170 (requires institutional sign-in at Scopus site) 45 CitationsAbstract
BACKGROUND: Numerous medical organizations recommend a multifaceted approach to the assessment of concussion occurring during sporting events. A number of tools are available to clinicians, with a wide breadth of sensitivity and specificity; however, little work has been done to evaluate the combined efficiency of these tools in concussed male and female athletes from a broad array of collegiate sports and with variable time from the pre-season baseline evaluation.
OBJECTIVE: The aim of this study was to optimize the concussion assessment battery for application within the first 72 h of injury, and to identify the necessary baseline retesting frequency.
METHODS: Between 2014 and 2017, a total of 1458 National Collegiate Athletic Association (NCAA) athletes sustaining 1640 diagnosed concussions completed a baseline assessment each year of the investigation and were evaluated up to three times within the first 72 h of injury using a standardized assessment protocol. Classification and regression tree analyses were implemented to identify the most efficient multifaceted assessment pathway to quantify concussion-related outcomes. Results were optimized for assessments occurring within 1 h post-injury, 1-24 h post-injury, and 24-72 h post-injury when using the raw post-injury assessment performance, difference scores from baseline evaluations occurring in the same year, and difference scores from baseline evaluations occurring the year prior.
RESULTS: At each of the assessment time points, the analyses indicated that alone or in combination, a symptom evaluation, Balance Error Scoring System (BESS) scores collected on the firm surface, and Standardized Assessment of Concussion (SAC) total score offered the best overall performance when compared with pre-morbid performance captured in the same season. Optimized sensitivity of the multifaceted approach was 61% within 1 h of injury, 67% at the 1-24 h interval, and 55% at the 24-72 h interval when difference scores from the same-season baseline were available.
CONCLUSIONS: This investigation identified key concussion assessments in quantifying post-concussion performance among student athletes, that were maximized when same-season pre-morbid evaluations were available. Consistent with clinical recommendations, medical professionals should continue to focus on symptom reporting, postural control, and neurocognitive screening to support the clinical examination when making a concussion diagnosis.
Author List
Broglio SP, Harezlak J, Katz B, Zhao S, McAllister T, McCrea M, CARE Consortium InvestigatorsAuthor
Michael McCrea PhD Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AthletesAthletic Injuries
Brain Concussion
Female
Humans
Male
Neuropsychological Tests
Postural Balance
Sensitivity and Specificity
Sports Medicine
