Concussion Assessment Across Several Clinical Batteries: Identifying the Components That Best Discriminate Injured Adolescents From Controls

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S11.2-S11
Author(s):  
Kristy Arbogast ◽  
Francesca Mandel ◽  
Mr. Daniel Corwin ◽  
Fairuz Mohammed ◽  
Catherine McDonald ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Principal Component ◽  
Forward Selection ◽  
Clinical Assessments ◽  
Ocular Reflex ◽  
Immediate Recall ◽  
Vestibular Ocular Reflex ◽  
Sport Concussion ◽  
Concussion History ◽  
Improved Model

ObjectiveTo identify which sub-components of 4 clinical assessments optimize concussion diagnosis.BackgroundMultiple assessments are part of the clinical toolbox for diagnosing concussions in youth, including the Post-Concussion Symptom Inventory (PCSI), the visio-vestibular exam (VVE), the King-Devick (KD) assessment, and the Sport Concussion Assessment Tool (SCAT-5). Most of these assessments have sub-components that likely overlap in aspects of brain function they assess. Discerning the combination of sub-components that best discriminate concussed adolescents (cases) from uninjured controls would streamline concussion assessment.Design/MethodsParticipants, 12–18 years, were prospectively enrolled from August 1, 2017 to April 29, 2020 Controls (n = 189, 53% female) were recruited from a suburban high school with PCSI, VVE, KD and SCAT-5 assessments associated with their sport seasons. Cases (n = 213, 52% female) were recruited from a specialty care concussion program, with the same assessments performed ≤28 days from injury. We implemented a forward-selection sparse principal component (PC) regression procedure to group sub-components into interpretable PCs and identify the PCs best able to discriminate cases from controls while accounting for age, sex, and concussion history.ResultsThe AUC of the baseline model with age, sex, and concussion history was 62%. The PC that combined all 5 sub-components of PCSI and SCAT-5 symptom count and symptom severity provided the largest AUC increase (+10.6%) relative to baseline. Other PC factors representing (1) KD completion time, (2) Errors in BESS tandem and double-leg stances, and (C) horizontal/vertical saccades and vestibular-ocular reflex also improved model AUC relative to baseline by 5.6%, 4.7%, and 4.5%, respectively. In contrast, the SCAT5 immediate recall test and right/left monocular accommodation did little to uniquely contribute to discrimination (<1% gain in AUC). Overall, the best model included 5 PCs (AUC = 77%).ConclusionsThese data show overlapping features of clinical batteries, with symptoms providing the strongest discrimination, but unique features obtained from neurocognitive, vision, and vestibular testing.

scholarly journals Symptoms and Vestibular Screening in Pediatric Concussion

2019 ◽  
Vol 34 (5) ◽  
pp. 763-763
Author(s):  
V Fazio Sumrok ◽  
N Kegel ◽  
N Blaney ◽  
A Colorito ◽  
K Viggiano ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Assessment Tool ◽  
Descriptive Statistics ◽  
Population Characteristics ◽  
Return To Play ◽  
Ocular Motor ◽  
Clinical Assessments ◽  
Pediatric Concussion ◽  
Sport Concussion ◽  
Symptom Ratings

Abstract Purpose Purpose: Children under age 11 participate in sports with a risk of concussion. Tools are limited for assessment. Clinicians rely on exam for management and return to play. Researchers have started assessment adaptation: Sport Concussion Assessment Tool-5 Child (SCAT-5 Child) (Davis et al., 2017) and Vestibular/Ocular Motor Screening (VOMS) (Mucha et al., 2014). The purpose of this study was to compare scores on components of the SCAT-5 Child, Pediatric VOMS, and SCAT-5 Parent. Methods Method: Participants included 59 children (M-33/26-F) aged 5-10 (7.50±1.17) within 30 days from concussion. Participants completed the SCAT-5 Child, SCAT-5 parent, and Pediatric VOMS at all visits. Descriptive statistics were used to calculate population characteristics. Paired t-tests were used to compare measures. Results Results: 42.6% (n=25) reported symptoms on VOMS at first visit. Only 10.0% reported symptom on VOMS (p=.003) at second visit. VOMS scores were improved across visits (p=.003). Participants reported decreases in symptom severity (p<.001) and number (p<.001) on the SCAT-5 Child across visits. Parents reported decreases in symptom severity (p=.009) and number (p=.005). Both children (p=.001) and parents (p=.001) reported significant increases in BTN% across visits. Participants and parent reported similar scores in number of symptoms, severity, and BTN% on the SCAT-5 at both visits. Conclusion Conclusions: Results demonstrate the Pediatric VOMS assessment is useful to evaluate vestibular/ocular impairment. The SCAT-5 Child and Parent do not evaluate these areas. Symptom ratings decrease and are similar between parent and child, indicating this measure remains consistent across reporters. Findings highlight needed expansion of clinical assessments and research in pediatrics.

scholarly journals Sport Concussion Assessment Tool Symptom Inventory: Healthy and Acute Postconcussion Symptom Factor Structures

2020 ◽  
Vol 55 (10) ◽  
pp. 1046-1053
Author(s):  
Morgan Anderson ◽  
Kyle M. Petit ◽  
Abigail C. Bretzin ◽  
R.J. Elbin ◽  
Katie L. Stephenson ◽  
...  
Keyword(s):  
High School ◽  
Neck Pain ◽  
Factor Structure ◽  
Assessment Tool ◽  
Case Series ◽  
Collegiate Athletes ◽  
Principal Component ◽  
Factor Solution ◽  
Symptom Inventory ◽  
Sport Concussion

Context Previous researchers have examined factor structures for common concussion symptom inventories. However, they failed to discriminate between the acute (&lt;72 hours) and subacute (3 days–3 months) periods after concussion. The Sport Concussion Assessment Tool (SCAT) is an acute assessment that, when compared with other concussion symptom inventories, includes or excludes symptoms that may result in different symptom factors. Objective The primary purpose was to investigate the symptom factor structure of the 22-item SCAT symptom inventory in healthy, uninjured and acutely concussed high school and collegiate athletes. The secondary purpose was to document the frequency of the unique SCAT symptom inventory items. Design Case series. Setting High school and college. Patients or Other Participants A total of 1334 healthy, uninjured and 200 acutely concussed high school and collegiate athletes. Main Outcome Measure(s) Healthy, uninjured participants completed the SCAT symptom inventory at a single assessment. Participants in the acutely concussed sample completed the SCAT symptom inventory within 72 hours after concussion. Two separate exploratory factor analyses (EFAs) using a principal component analysis and varimax extraction method were conducted. Results A 3-factor solution accounted for 48.1% of the total variance for the healthy, uninjured sample: cognitive-fatigue (eg, feeling “in a fog” and “don't feel right”), migraine (eg, neck pain and headache), and affective (eg, more emotional and sadness) symptom factors. A 3-factor solution accounted for 55.0% of the variance for the acutely concussed sample: migraine-fatigue (eg, headache and “pressure in the head”), affective (eg, sadness and more emotional), and cognitive-ocular (eg, difficulty remembering and balance problems) symptom factors. Conclusions The inclusion of unique SCAT symptom inventory items did not alter the symptom factor structure for the healthy, uninjured sample. For the acutely concussed sample, all but 1 unique SCAT symptom inventory item (neck pain) loaded onto a factor.

Discriminative Validity of Vestibular Ocular Motor Screening in Identifying Concussion Among Collegiate Athletes: A National Collegiate Athletic Association–Department of Defense Concussion Assessment, Research, and Education Consortium Study

2021 ◽  
pp. 036354652110123
Author(s):  
Anthony P. Kontos ◽  
Shawn R. Eagle ◽  
Gregory Marchetti ◽  
Aaron Sinnott ◽  
Anne Mucha ◽  
...  
Keyword(s):  
Department Of Defense ◽  
National Collegiate Athletic Association ◽  
Collegiate Athletes ◽  
Ocular Motor ◽  
Predictive Utility ◽  
Ocular Reflex ◽  
Vestibular Ocular Reflex ◽  
Concussion History ◽  
Research And Education ◽  
Assessment Research

Background: Vestibular and ocular motor screening tools, such as the Vestibular/Ocular Motor Screening (VOMS), are recognized as important components of a multifaceted evaluation of sport-related concussion. Previous research has supported the predictive utility of the VOMS in identifying concussion, but researchers have yet to examine the predictive utility of the VOMS among collegiate athletes in the first few days after injury. Purpose: To determine the discriminative validity of individual VOMS item scores and an overall VOMS score for identifying collegiate athletes with an acute sport-related concussion (≤72 hours) from healthy controls matched by age, sex, and concussion history. Study Design: Case-control study; Level of evidence, 3. Methods: Participants (N = 570) aged 17 to 25 years were included from 8 institutions of the National Collegiate Athletic Association–Department of Defense CARE Consortium (Concussion Assessment, Research, and Education): 285 athletes who were concussed (per current consensus guidelines) and 285 healthy controls matched by age, sex, and concussion history. Participants completed the VOMS within 3 days of injury (concussion) or during preseason (ie, baseline; control). Symptoms are totaled for each VOMS item for an item score (maximum, 40) and totaled across items for an overall score (maximum, 280), and distance (centimeters) for near point of convergence (NPC) is averaged across 3 trials. Receiver operating characteristic analysis of the area under the curve (AUC) was performed on cutoff scores using Youden index ( J) for each VOMS item, overall VOMS score, and NPC distance average. A logistic regression was conducted to identify which VOMS scores identified concussed status. Results: A symptom score ≥1 on each VOMS item and horizontal vestibular/ocular reflex ≥2 significantly discriminated concussion from control (AUC, 0.89-0.90). NPC distance did not significantly identify concussion from control (AUC, 0.51). The VOMS overall score had the highest accuracy (AUC, 0.91) for identifying sport-related concussion from control. Among the individual items, vertical saccades ≥1 and horizontal vestibular/ocular reflex ≥2 best discriminated concussion from control. Conclusion: The findings indicate that individual VOMS items and overall VOMS scores are useful in identifying concussion in collegiate athletes within 3 days of injury. Clinicians can use the cutoffs from this study to help identify concussion in collegiate athletes.

scholarly journals Sport Concussion Assessment Tool Symptom Inventory: Healthy and Acute Postconcussion Symptom Factor Structures

2020 ◽  
Author(s):  
Morgan Anderson ◽  
Kyle M. Petit ◽  
Abigail C. Bretzin ◽  
R.J. Elbin ◽  
Katie Stephenson-Brown ◽  
...  
Keyword(s):  
High School ◽  
Neck Pain ◽  
Factor Structure ◽  
Assessment Tool ◽  
Case Series ◽  
Collegiate Athletes ◽  
Principal Component ◽  
Factor Solution ◽  
Symptom Inventory ◽  
Sport Concussion

Context Previous researchers have examined factor structures for common concussion symptom inventories. However, they failed to discriminate between the acute (&lt;72 hours) and subacute (3 days–3 months) periods after concussion. The Sport Concussion Assessment Tool (SCAT) is an acute assessment that, when compared with other concussion symptom inventories, includes or excludes symptoms that may result in different symptom factors. Objective The primary purpose was to investigate the symptom factor structure of the 22-item SCAT symptom inventory in healthy, uninjured and acutely concussed high school and collegiate athletes. The secondary purpose was to document the frequency of the unique SCAT symptom inventory items. Design Case series. Setting High school and college. Patients or Other Participants A total of 1334 healthy, uninjured and 200 acutely concussed high school and collegiate athletes. Main Outcome Measure(s) Healthy, uninjured participants completed the SCAT symptom inventory at a single assessment. Participants in the acutely concussed sample completed the SCAT symptom inventory within 72 hours after concussion. Two separate exploratory factor analyses (EFAs) using a principal component analysis and varimax extraction method were conducted. Results A 3-factor solution accounted for 48.1% of the total variance for the healthy, uninjured sample: cognitive fatigue (eg, feeling “in a fog” and “don't feel right”), migraine (eg, neck pain and headache), and affective (eg, more emotional and sadness) symptom factors. A 3-factor solution accounted for 55.0% of the variance for the acutely concussed sample: migraine fatigue (eg, headache and “pressure in the head”), affective (eg, sadness and more emotional), and cognitive ocular (eg, difficulty remembering and balance problems) symptom factors. Conclusions The inclusion of unique SCAT symptom inventory items did not alter the symptom factor structure for the healthy, uninjured sample. For the acute concussed sample, all but 1 unique SCAT symptom inventory item (neck pain) loaded onto a factor.

scholarly journals Comparison of baseline and postconcussion SCAT3 scores and symptoms in varsity athletes: an investigation into differences by sex and history of concussion

2018 ◽  
Vol 4 (1) ◽  
pp. e000312 ◽  
Author(s):  
Johanna M Hurtubise ◽  
Cindy E Hughes ◽  
Lauren E Sergio ◽  
Alison K Macpherson
Keyword(s):  
Chart Review ◽  
Assessment Tool ◽  
Retrospective Chart Review ◽  
Symptom Reporting ◽  
Sport Concussion ◽  
Varsity Athletes ◽  
History Of ◽  
Concussion History ◽  
Clinically Significant ◽  
Or History

ObjectiveTo investigate the use of the Sport Concussion Assessment Tool 3 (SCAT3) as an assessment tool in the varsity population, as well as the effects of sex and concussion history on both baseline and postconcussion scores.MethodsA comparison between baseline and postconcussion SCAT3 scores of varsity level athletes was conducted through retrospective chart review. Differences in both baseline and postconcussion scores were further analysed by sex and history of concussion.ResultsThe only clinically significant change on the SCAT3 elicited by a concussion was that of self-reported symptoms. There were no clinically significant differences based on sex or history of concussion.ConclusionThe SCAT3 in its entirety may not be useful in this population. Additional research on sociocultural and sport aspects that may be affecting symptom reporting in this population is needed.

scholarly journals Baseline Performance of High School Rugby Players on the Sport Concussion Assessment Tool 5

2020 ◽  
Vol 55 (2) ◽  
pp. 116-123
Author(s):  
Amanda M. Black ◽  
Lauren N. Miutz ◽  
Vineetha Warriyar KV ◽  
Kathryn J. Schneider ◽  
Keith Owen Yeates ◽  
...  
Keyword(s):  
High School ◽  
Symptom Severity ◽  
Assessment Tool ◽  
Word List ◽  
Rugby Union ◽  
Symptom Scale ◽  
Cross Sectional ◽  
Immediate Memory ◽  
Sport Concussion ◽  
Concussion History

Context Version 5 of the Sport Concussion Assessment Tool (SCAT5) was released in 2017 with an additional 10-word list option in the memory section and additional instructions for completing the symptom scale. Objective To provide reference scores for high school rugby union players on the SCAT5, including immediate memory using the 10-word list, and examine how age, sex, and concussion history affected performance. Design Cross-sectional study. Setting Calgary, Alberta high schools. Patients or Other Participants High school rugby union players (ages 15–18 years) participating in a 2018 season cohort study (n = 380, males = 210, females = 170). Main Outcome Measure(s) Sport Concussion Assessment Tool 5 scores, including total number of symptoms (of 20), symptom severity (of 132), 10-word immediate memory (of 30), delayed memory (of 10), modified Standardized Assessment of Concussion (of 50), and balance examination (of 30). Results The median number of symptoms reported at baseline ranged from 5 to 8 across sex and age stratifications. Median symptom severity was lowest in males with no concussion history (7; range, 0–28) and highest in females with a concussion history (13, range = 0–45). Median total scores on immediate memory were 2–3 (range = 0–4) for males and 21 (range = 9–29) for females. Median total scores were 3 (range = 0–4) on digits backward and 7 (range = 0–20) on delayed memory (all groups). Based on simultaneous quantile (q) regression at 0.50 and 0.75, adjusted for age and concussion history, being female was associated with a higher total symptoms score (q0.75 βfemale = 2.85; 99% confidence interval [CI] = 0.33, 5.37), higher total symptom severity score (q0.75 βfemale = 8.00; 99% CI = 2.83, 13.17), and lower number of errors on the balance examination (q0.75 βfemale = −3.00; 99% CI = −4.85, −1.15). Age and concussion history were not associated with any summary measures. Conclusions The 10-word list option in the memory section reduced the likelihood of a ceiling effect. A player's sex may be an important consideration when interpreting the SCAT5 after concussion.

Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes

2019 ◽  
Vol 23 (4) ◽  
pp. 465-470 ◽  
Author(s):  
Ryan N. Moran ◽  
Tracey Covassin ◽  
Jessica Wallace
Keyword(s):  
Risk Factor ◽  
Smooth Pursuit ◽  
Migraine Headache ◽  
Visual Motion ◽  
Assessment Tools ◽  
Motion Sensitivity ◽  
Ocular Reflex ◽  
Migraine Headaches ◽  
Vestibular Ocular Reflex ◽  
History Of

OBJECTIVEMigraine history has recently been identified as a risk factor for concussion and recovery. The authors performed a cross-sectional study examining baseline outcome measures on newly developed and implemented concussion assessment tools in pediatrics. The purpose of this study was to examine the effects of premorbid, diagnosed migraine headaches as a risk factor on vestibular and oculomotor baseline assessment in pediatric athletes.METHODSPediatric athletes between the ages of 8 and 14 years with a diagnosed history of migraine headache (n = 28) and matched controls without a history of diagnosed migraine headache (n = 28) were administered a baseline concussion assessment battery, consisting of the Vestibular/Ocular Motor Screening (VOMS), near point of convergence (NPC), and the King-Devick (K-D) tests. Between-groups comparisons were performed for vestibular symptoms and provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular/ocular reflex, visual motion sensitivity), NPC (average distance), and K-D (time).RESULTSIndividuals diagnosed with migraine headaches reported greater VOMS smooth pursuit scores (p = 0.02), convergence scores (p = 0.04), vestibular ocular reflex scores (p value range 0.002–0.04), and visual motion sensitivity scores (p = 0.009). Differences were also observed on K-D oculomotor performance with worse times in those diagnosed with migraine headache (p = 0.02). No differences were reported on NPC distance (p = 0.06) or headache symptom reporting (p = 0.07) prior to the VOMS assessment.CONCLUSIONSPediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches.

scholarly journals Knowledge and attitudes towards concussion in UK-based male ice hockey players: A need for attitude change?

2019 ◽  
Vol 14 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Sarah Hutchinson ◽  
Paul Ellison ◽  
Andrew Levy ◽  
David Marchant
Keyword(s):  
Attitude Change ◽  
Ice Hockey ◽  
Knowledge And Attitudes ◽  
Accurate Knowledge ◽  
Hockey Players ◽  
Sport Concussion ◽  
Concussion History ◽  
Concussion Knowledge ◽  
The Uk

Objective Concussion is a common injury in ice hockey, and previous research suggests some misconceptions and unsafe attitudes amongst players. The purpose of this study was to assess sport concussion knowledge, attitudes and the effect of sport concussion history in UK-based male ice hockey players across three levels of competition: professional, semi-professional and amateur. Methods Sixty-one participants across a number of UK ice hockey teams completed the Rosenbaum Concussion Knowledge and Attitudes Survey and reviewed a series of statements to assess knowledge (concussion knowledge index), attitudes (concussion attitude index) and misconceptions of concussion. Results Level of competition and concussion history had no significant effect on concussion knowledge index or concussion attitude index. A positive significant relationship exists between playing experience and concussion knowledge index and concussion attitude index. Statements identified common misconceptions and areas of accurate knowledge regarding concussion symptoms suggesting that male ice hockey players have a higher level knowledge compared to a sample of the UK general public. Playing experience was associated with increased knowledge and increasingly safe attitudes towards concussion. Conclusion Despite knowledge relating to loss of consciousness and correct management of symptoms being generally accurate, there are worryingly unsafe attitudes regarding aspects of concussion. Such attitudes may well pose significant threats to players’ safety and long-term health.

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