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Wethe JV, Bogle J, Dodick DW, Howard MD, Gould AR, Butterfield RJ, Buras MR, Adler J, Talaber A, Soma D, Starling AJ. Baseline Normative and Test-Retest Reliability Data for Sideline Concussion Assessment Measures in Youth. Diagnostics (Basel) 2024; 14:1661. [PMID: 39125537 PMCID: PMC11311299 DOI: 10.3390/diagnostics14151661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Tools used for the identification, evaluation, and monitoring of concussion have not been sufficiently studied in youth or real-world settings. Normative and reliability data on sideline concussion assessment measures in the youth athlete population is needed. Pre-season normative data for 515 athletes (93.5% male) aged 5 to 16 on the Standardized Assessment of Concussion (SAC/SAC-Child), modified Balance Errors Scoring System (mBESS), Timed Tandem Gait (TTG), and the King-Devick Test (KDT) are provided. A total of 212 non-injured athletes repeated the measures post-season to assess test-retest reliability. Mean performance on the SAC-C, mBESS, TTG, and KDT tended to improve with age. KDT was the only measure that demonstrated good to excellent stability across age ranges (ICC = 0.758 to 0.941). Concentration was the only SAC/SAC-C subtest to demonstrate moderate test-retest stability (ICC = 0.503 to 0.706). TTG demonstrated moderate to good (ICC = 0.666 to 0.811) reliability. mBESS demonstrated poor to moderate reliability (ICC = -0.309 to 0.651). Commonly used measures of concussion vary regarding test-retest reliability in youth. The data support the use of at least annual sport concussion baseline assessments in the pediatric population to account for the evolution in performance as the child ages. Understanding the variation in the stability and the evolution of baseline performance will enable improved identification of possible injury.
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Affiliation(s)
- Jennifer V. Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine and Science, Scottsdale, AZ 85259, USA
| | - Jamie Bogle
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine and Science, Scottsdale, AZ 85259, USA
| | - David W. Dodick
- Department of Neurology, Mayo Clinic School of Medicine and Science, Scottsdale, AZ 85259, USA
| | - Marci D. Howard
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine and Science, Scottsdale, AZ 85259, USA
| | - Amanda Rach Gould
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine and Science, Scottsdale, AZ 85259, USA
| | - Richard J. Butterfield
- Division of Biostatistics and Clinical Trials, Department of Quantitative Health Sciences, Scottsdale, AZ 85259, USA
| | - Matthew R. Buras
- Division of Biostatistics and Clinical Trials, Department of Quantitative Health Sciences, Scottsdale, AZ 85259, USA
| | - Jennifer Adler
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine and Science, Scottsdale, AZ 85259, USA
| | | | - David Soma
- Department of Pediatric and Adolescent Medicine, Department of Orthopedic Surgery, Mayo Clinic School of Medicine and Science, Rochester, MN 55905, USA
| | - Amaal J. Starling
- Department of Neurology, Mayo Clinic School of Medicine and Science, Scottsdale, AZ 85259, USA
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Kelshaw PM, Fine AC, Beidler E, Caswell SV. Language Matters: Comparisons of Concussion Assessments Among English- and Spanish-Speaking Middle School Athletes. J Athl Train 2024; 59:493-498. [PMID: 38014793 PMCID: PMC11127669 DOI: 10.4085/1062-6050-0362.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CONTEXT The Child Sport Concussion Assessment Tool, fifth edition (Child SCAT5), is among the most widely used international pediatric concussion evaluation tools. However, the tool's English-only aspect may limit its use for patients who speak different languages. Prior researchers have suggested one's preferred language (ie, home language) could be associated with concussion assessments in adults, yet how this might affect pediatric athletes is not well understood. OBJECTIVE To compare baseline Child SCAT5 assessment outcomes between middle school athletes whose home language was Spanish and matched control athletes whose home language was English. DESIGN Case-control study. SETTING Middle school athletics. PATIENTS OR OTHER PARTICIPANTS Athletes self-reported their home language (ie, language spoken at home). Those indicating their home language was Spanish were individually matched to athletes who spoke English at home on age, sex, sport, school, and pertinent comorbidities (eg, concussion history). The final sample consisted of 144 athletes (Spanish home language = 72, English home language = 72). MAIN OUTCOME MEASURE(S) We used Mann-Whitney U tests to compare the Child SCAT5 component scores of the home language groups (ie, Spanish versus English). RESULTS Athletes in the Spanish home language group scored lower on the Standardized Assessment of Concussion-Child version (P < .01, r = -0.25), Immediate Memory (P < .01, r = -0.45), and total modified Balance Error Scoring System scores (P < .01, r = -0.25) than the English home language group. CONCLUSIONS Matched athletes whose home language was Spanish versus English scored differently on baseline Child SCAT5 assessment components. Those with the home language of Spanish scored lower on cognitive and balance tasks than those whose home language was English. These findings may serve as a rationale for the development of future concussion assessment tools to properly capture clinically relevant data regarding language differences among pediatric athletes.
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Affiliation(s)
- Patricia M. Kelshaw
- Department of Kinesiology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham
| | - Alicia C. Fine
- Department of Kinesiology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, PA
| | - Shane V. Caswell
- School of Kinesiology, Virginia Concussion Initiative, Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project, and Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas
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Moran RN, Haller M, Louis M, Guin JR, Allen J. Level of Agreement Between Child and Parent Reporting on the Child Sport Concussion Assessment Tool (SCAT5). J Athl Train 2024; 59:137-144. [PMID: 38343167 PMCID: PMC10895391 DOI: 10.4085/1062-6050-0629.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
CONTEXT The Child Sport Concussion Assessment Tool, fifth edition (SCAT5), remains the consensus instrument for concussion evaluation in youth athletes. Both child and parent are recommended to complete the athlete background and symptom reporting. OBJECTIVE To determine the level of agreement between child and parent medical history and symptom reporting and quantify their performance on the Child SCAT5 in male football athletes. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Division I college football facility. PATIENTS OR OTHER PARTICIPANTS A total of 157 youth male football athletes (age = 10.7 ± 1.3 years) participating in a university-sanctioned youth football camp and their parent or legal guardian. MAIN OUTCOME MEASURE(S) Youth athletes and their parent completed the athlete background (demographics, diagnosed medical history) and symptom evaluation (symptom items, total number of symptoms, and symptom severity score) of the Child SCAT5 and were instructed not to discuss reporting with each other during testing. Cronbach α tests were conducted to determine the internal consistency, and descriptive statistics determined the level of agreement between medical history, symptom reporting, and baseline performance. RESULTS The internal consistency of the symptom items was high for both child (Cronbach α = 0.91) and parent (α = 0.92). Agreement on medical history ranged from 67% (learning disability or dyslexia) to 85% (attention-deficit/hyperactivity disorder), with 82% agreement on sustaining a previous concussion. Fourteen youth athletes reported having been hospitalized for a head injury, with zero matched parent confirmations. Individual symptom agreement ranged from 70.7% (gets distracted easily) to 94.9% (going to faint). Agreement was 35% on total number of symptoms and severity. Abnormal scoring ranged from 2% (going to faint) to 25% (headache) for child and 2% (double vision) to 28% (gets distracted easily) for parent reporting. CONCLUSIONS Fair agreement was shown between children and their parent on medical history and self-reported symptoms on the Child SCAT5 at baseline. When available, child and parent reporting should be used for concussion assessment and clinical decision-making.
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Affiliation(s)
- Ryan N. Moran
- Athletic Training Research Laboratory, The University of Alabama, Tuscaloosa
- Department of Intercollegiate Athletics, The University of Alabama, Tuscaloosa
| | - Mason Haller
- Athletic Training Research Laboratory, The University of Alabama, Tuscaloosa
| | - Melanie Louis
- Athletic Training Research Laboratory, The University of Alabama, Tuscaloosa
| | - J. Russell Guin
- Department of Intercollegiate Athletics, The University of Alabama, Tuscaloosa
- College of Community Health Sciences, The University of Alabama, Tuscaloosa
| | - Jeff Allen
- Department of Intercollegiate Athletics, The University of Alabama, Tuscaloosa
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Davis GA, Schneider KJ, Anderson V, Babl FE, Barlow KM, Blauwet CA, Bressan S, Broglio SP, Emery CA, Echemendia RJ, Gagnon I, Gioia GA, Giza CC, Leddy JJ, Master CL, McCrea M, McNamee MJ, Meehan WP, Purcell L, Putukian M, Moser RS, Takagi M, Yeates KO, Zemek R, Patricios JS. Pediatric Sport-Related Concussion: Recommendations From the Amsterdam Consensus Statement 2023. Pediatrics 2024; 153:e2023063489. [PMID: 38044802 DOI: 10.1542/peds.2023-063489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
The 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022, addressed sport-related concussion (SRC) in adults, adolescents, and children. We highlight the updated evidence-base and recommendations regarding SRC in children (5-12 years) and adolescents (13-18 years). Prevention strategies demonstrate lower SRC rates with mouthguard use, policy disallowing bodychecking in ice hockey, and neuromuscular training in adolescent rugby. The Sport Concussion Assessment Tools (SCAT) demonstrate robustness with the parent and child symptom scales, with the best diagnostic discrimination within the first 72 hours postinjury. Subacute evaluation (>72 hours) requires a multimodal tool incorporating symptom scales, balance measures, cognitive, oculomotor and vestibular, mental health, and sleep assessment, to which end the Sport Concussion Office Assessment Tools (SCOAT6 [13+] and Child SCOAT6 [8-12]) were developed. Rather than strict rest, early return to light physical activity and reduced screen time facilitate recovery. Cervicovestibular rehabilitation is recommended for adolescents with dizziness, neck pain, and/or headaches for greater than 10 days. Active rehabilitation and collaborative care for adolescents with persisting symptoms for more than 30 days may decrease symptoms. No tests and measures other than standardized and validated symptom rating scales are valid for diagnosing persisting symptoms after concussion. Fluid and imaging biomarkers currently have limited clinical utility in diagnosing or assessing recovery from SRC. Improved paradigms for return to school were developed. The variable nature of disability and differences in evaluating para athletes and those of diverse ethnicity, sex, and gender are discussed, as are ethical considerations and future directions in pediatric SRC research.
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Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia
- Neurosurgery, Cabrini Health, Melbourne, Victoria, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Victoria, Australia
| | - Karen M Barlow
- University of Queensland, Children's Hospital and Health Services,Brisbane, Queensland, Australia
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
| | - Ruben J Echemendia
- University Orthopedics Concussion Care Clinic, State College, Pennsylvania
- University of Missouri - Kansas City, Kansas City, Missouri
| | - Isabelle Gagnon
- McGill University, Montreal, Quebec, Canada
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - John J Leddy
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Christina L Master
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Keith Owen Yeates
- Hotchkiss Brain Institute
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Dunne LAM, Cole MH, Cormack SJ, Howell DR, Johnston RD. Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:76. [PMID: 37578611 PMCID: PMC10425315 DOI: 10.1186/s40798-023-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs. OBJECTIVES This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users. METHODS A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality. RESULTS A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments. CONCLUSION These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion. TRAIL REGISTRATION This systematic review was registered on PROSPERO (reg no. CRD42021256298).
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Affiliation(s)
- Laura A M Dunne
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Stuart J Cormack
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rich D Johnston
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Carnegie Applied Rugby Research Centre, School of Sport, Leeds Beckett University, Leeds, UK
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Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Erdman NK, Kelshaw PM, Hacherl SL, Caswell SV. The Clinical Utility of the Child SCAT5 for Acute Concussion Assessment. SPORTS MEDICINE - OPEN 2022; 8:104. [PMID: 35962887 PMCID: PMC9375738 DOI: 10.1186/s40798-022-00499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/31/2022] [Indexed: 11/11/2022]
Abstract
Background The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5 and 12 years of age for a suspected concussion. However, limited empirical evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion. Methods Our participants included 34 concussed (21 boys, 13 girls; age = 12.8 ± 0.86 years) and 44 non-concussed (31 boys, 13 girls; age = 12.4 ± 0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes (\documentclass[12pt]{minimal}
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Results Concussed children endorsed more symptoms (p < 0.001, \documentclass[12pt]{minimal}
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\begin{document}$$r$$\end{document}r=0.44), and had higher double leg (p = 0.046, \documentclass[12pt]{minimal}
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\begin{document}$$r$$\end{document}r=0.23), single leg (p = 0.035, \documentclass[12pt]{minimal}
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\begin{document}$$r$$\end{document}r=0.24), and total scores (p = 0.022, \documentclass[12pt]{minimal}
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\begin{document}$$r$$\end{document}r=0.26) for the mBESS than the non-concussed children. No significant differences were observed for the SAC-C scores (p’s ≥ 0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC = 0.76–0.77), negative predictive values (NPV = 0.84–0.88), and negative likelihood ratios (-LR = 0.22–0.31) of the Child SCAT5 scores. Conclusions Clinicians should prioritize interpretation of the symptom evaluation form of the Child SCAT5 as it was the most effective component for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.
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Kelshaw PM, Cook NE, Terry DP, Iverson GL, Caswell SV. Child Sport Concussion Assessment Tool 5th Edition: Normative Reference Values in Demographically Diverse Youth. Clin J Sport Med 2022; 32:e126-e133. [PMID: 34009797 DOI: 10.1097/jsm.0000000000000921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Examine sociodemographic differences (gender, age, and language spoken at home) on baseline Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) scores and establish normative reference data for the Child SCAT5 among middle school student athletes. DESIGN Cross-sectional study. SETTING Nine middle schools in Virginia. PARTICIPANTS A sample of 1355 athletes playing competitive school-sponsored sports (ages 11-13, M = 12.3 ± 0.8; 40.1% girls, 59.9% boys) during the 2017 and 2018 school year. Certified athletic trainers administered the Child SCAT5 within the first 2 weeks of the sport season. INDEPENDENT VARIABLES Self-reported gender, age, and language spoken at home. MAIN OUTCOME MEASURES All Child SCAT5 outcome measures. RESULTS Gender, age, and language spoken at home were associated with Child SCAT5 scores, but the magnitude of differences was generally small. Specifically, girls endorsed more symptoms (girls: M = 8.4 ± 5.7, boys: M = 7.5 ± 5.7; P = 0.003) and greater symptom severity (girls: M = 11.6 ± 9.4, boys: M = 10.4 ± 9.3; P = 0.006) than boys and performed slightly better than boys on cognitive and balance tasks. Older students performed slightly better than younger students on tests of cognition (eg, SAC-C: 11-year-olds: M = 21.3 ± 2.1, 13-year-olds: M = 21.7 ± 2.1; P = 0.02). Total symptoms (P = 0.01), symptom severity (P = 0.01), immediate memory (P < 0.001), delayed recall (P = 0.001), and SAC-C total scores (P = 0.002) differed across language groups. CONCLUSIONS Gender, age, and language spoken in the home are associated with baseline scores on multiple components of the Child SCAT5 among middle school students, although the magnitudes of observed differences are small. Normative reference values are provided for clinicians when interpreting Child SCAT5 scores.
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Affiliation(s)
- Patricia M Kelshaw
- Athletic Training Program, Department of Kinesiology, University of New Hampshire, Durham, New Hampshire
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Advancing Healthcare Initiatives for Underserved Students (ACHIEVES), Institute for BioHealth Innovation, George Mason University, Manassas, Virginia
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
- Neuropsychology Outcome Assessment Laboratory, Center for Health and Rehabilitation Research, Charlestown, Massachusetts
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts; and
| | - Shane V Caswell
- Athletic Training Education Program, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, School of Kinesiology, Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project, George Mason University, Manassas, Virginia
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9
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Kelshaw PM, Cook NE, Terry DP, Cortes N, Iverson GL, Caswell SV. Interpreting change on the Child Sport Concussion Assessment Tool, 5th edition. J Sci Med Sport 2022; 25:492-498. [DOI: 10.1016/j.jsams.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
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10
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O'Brien H, Minich NM, Langevin LM, Taylor HG, Bigler ED, Cohen DM, Beauchamp MH, Craig WR, Doan Q, Zemek R, Bacevice A, Mihalov LK, Yeates KO. Normative and Psychometric Characteristics of the Health and Behavior Inventory Among Children With Mild Orthopedic Injury Presenting to the Emergency Department: Implications for Assessing Postconcussive Symptoms Using the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). Clin J Sport Med 2021; 31:e221-e228. [PMID: 33973883 PMCID: PMC8416708 DOI: 10.1097/jsm.0000000000000943] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The study sought to present normative and psychometric data and reliable change formulas for the Health and Behavior Inventory (HBI), a postconcussive symptom rating scale embedded in the Child Sport Concussion Assessment Tool 5th edition (Child SCAT5). DESIGN Prospective cohort study with longitudinal follow-up. SETTING Pediatric emergency departments (EDs). PARTICIPANTS As part of 3 studies conducted in the United States and Canada between 2001 and 2019, 450 children aged 8 to 16 years with mild orthopedic injuries were recruited during ED visits and assessed postacutely (M = 9.38 days, SD = 3.31) and 1 month and 3 months postinjury. Independent variables were rater (child vs parent), sex, and age at injury. MAIN OUTCOME MEASURE HBI ratings. METHODS Children and parents rated children's symptoms at each time point; parents also rated children's preinjury symptoms retrospectively. Normative data (mean, SD, skewness, kurtosis, and percentiles) were computed for child and parent ratings. Internal consistency was assessed using Cronbach alpha (α), and test-retest reliability and interrater agreement were assessed with intraclass correlations (ICCs). Reliable change formulas were computed using linear regression and mixed models. RESULTS HBI ratings were positively skewed. Mean ratings and percentiles were stable over time. Child and parent ratings demonstrated good-to-excellent internal consistency (α 0.76-0.94) and moderate-to-good test-retest reliability (ICC 0.51-0.76 between adjacent assessments). However, parent-child agreement was poor to moderate (ICC 0.31-0.69). CONCLUSIONS The HBI demonstrates acceptable normative and psychometric characteristics. Modest parent-child agreement highlights the importance of multiple informants when assessing postconcussive symptoms. The results will facilitate the use of the HBI in research and clinical practice.
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Affiliation(s)
- Heidi O'Brien
- Werklund School of Education, University of Calgary, Calgary, AB
| | - Nori M Minich
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | | | - H Gerry Taylor
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, Utah
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Daniel M Cohen
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Miriam H Beauchamp
- Department of Psychology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC
| | - William R Craig
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB
| | - Quynh Doan
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON; and
| | - Ann Bacevice
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Leslie K Mihalov
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB
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11
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Babl FE, Anderson V, Rausa VC, Anderson N, Pugh R, Chau T, Clarke C, Fabiano F, Fan F, Hearps S, Parkin G, Takagi M, Davis G. Accuracy of Components of the SCAT5 and ChildSCAT5 to Identify Children with Concussion. Int J Sports Med 2021; 43:278-285. [PMID: 34399426 DOI: 10.1055/a-1533-1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Sport Concussion Assessment Tool 5th Edition (SCAT5) is a standardized measure of concussion. In this prospective observational study, the ability of the SCAT5 and ChildSCAT5 to differentiate between children with and without a concussion was examined. Concussed children (n=91) and controls (n=106) were recruited from an emergency department in three equal-sized age bands (5-8/9-12/13-16 years). Analysis of covariance models (adjusting for participant age) were used to analyze group differences on components of the SCAT5. On the SCAT5 and ChildSCAT5, respectively, youth with concussion reported a greater number (d=1.47; d=0.52) and severity (d=1.27; d=0.72) of symptoms than controls (all p<0.001). ChildSCAT5 parent-rated number (d=0.98) and severity (d=1.04) of symptoms were greater for the concussion group (all p<0.001). Acceptable levels of between-group discrimination were identified for SCAT5 symptom number (AUC=0.86) and severity (AUC=0.84) and ChildSCAT5 parent-rated symptom number (AUC=0.76) and severity (AUC=0.78). Our findings support the utility of the SCAT5 and ChildSCAT5 to accurately distinguish between children with and without a concussion.
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Affiliation(s)
- Franz E Babl
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne Department of Paediatrics, Parkville, Australia.,Emergency Department, The Royal Children's Hospital, Parkville, Australia
| | - Vicki Anderson
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia.,Department of School of Psychological Sciences, The University of Melbourne, Parkville, Australia.,Department of Psychology Service, The Royal Children's Hospital, Parkville, Australia
| | - Vanessa C Rausa
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Nicholas Anderson
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Remy Pugh
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Tracey Chau
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Cathriona Clarke
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Fabian Fabiano
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Feiven Fan
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Stephen Hearps
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Georgia Parkin
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
| | - Michael Takagi
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia.,Department of School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Gavin Davis
- Department of Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Neurosurgery, Austin Hospital, Heidelberg, Australia.,Department of Neurosurgery, Cabrini Hospital, Malvern, Australia
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12
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Sarmiento K, Daugherty J, Haarbauer-Krupa J. Healthcare Providers' Self-Reported Pediatric Mild Traumatic Brain Injury Diagnosis, Prognosis, and Management Practices: Findings From the 2019 DocStyles Survey. J Head Trauma Rehabil 2021; 36:282-292. [PMID: 33656487 PMCID: PMC8249309 DOI: 10.1097/htr.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess adherence to 5 key recommendations in the Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury, this article presents results from the 2019 DocStyles survey. STUDY DESIGN Cross-sectional, web-based survey of 653 healthcare providers. RESULTS Most healthcare providers reported adhering to the recommendations regarding the use of computed tomography and providing education and reassurance to patients and their families. However, less than half reported routinely examining their patients with mild traumatic brain injury (mTBI) using age-appropriate, validated symptom scales, assessing for risk factors for prolonged recovery, and advising patients to return to noncontact, light aerobic activities within 2 to 3 days. Self-reported mTBI diagnosis, prognosis, and management practices varied by specialty. Only 3.8% of healthcare providers answered all 7 questions in a way that is most consistent with the 5 recommendations examined from the Centers for Disease Control and Prevention Pediatric mTBI Guideline. CONCLUSION This study highlights several important information gaps regarding pediatric mTBI diagnosis and management. Further efforts to improve adoption of guideline recommendations may be beneficial to ensure optimal outcomes for children following an mTBI.
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Affiliation(s)
- Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA
| | - Jill Daugherty
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA
| | - Juliet Haarbauer-Krupa
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA
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13
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Kaufman MW, Su CA, Trivedi NN, Lee MK, Nelson GB, Cupp SA, Voos JE. The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202106000-00001. [PMID: 34101673 DOI: 10.2106/jbjs.rvw.20.00108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Concussion is a complex pathophysiologic process that affects the brain; it is induced by biomechanical forces, with alteration in mental status with or without loss of consciousness. » Concussion assessment tools may be broadly categorized into (1) screening tests such as the SAC (Standardized Assessment of Concussion), the BESS (Balance Error Scoring System), and the King-Devick (KD) test; (2) confirmatory tests including the SCAT (Sport Concussion Assessment Tool), the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and the VOMS (Vestibular Oculomotor Screening); and (3) objective examinations such as brain network activation (BNA) analysis, imaging studies, and physiologic markers. » The KD, child SCAT3 (cSCAT3), child ImPACT (cImPACT), and VOMS tests may be used to evaluate for concussion in the pediatric athlete. » Future work with BNA, functional magnetic resonance imaging, diffusion tensor imaging, and serum biomarkers may provide more objective assessment of concussion, neurologic injury, and subsequent recovery.
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Affiliation(s)
| | - Charles A Su
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nikunj N Trivedi
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michelle K Lee
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Grant B Nelson
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sean A Cupp
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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14
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Brown WD, Baird J, Kriz PK. A Battery of Easily Accessible, Simple Tools for the Assessment of Concussion in Children. J Pediatr 2021; 229:232-239.e1. [PMID: 33068568 DOI: 10.1016/j.jpeds.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether a non-proprietary, novel testing battery can identify recently concussed children within 8 weeks of injury. STUDY DESIGN In total, 568 clinic outpatients aged 10-18 years were sorted into 3 groups: 316 had never been concussed, 162 had ever been concussed before 8 weeks earlier, and 90 had been recently concussed within 8 weeks. At initial and any subsequent visits, a neurologic examination and 4 procedures were performed: Stick Drop, Wall Ball, Sharpened Modified Romberg (SMR), and Animal Naming. Analysis included inter-group and intra-person performance differences using a series of t tests on the Stick Drop, Wall Ball, SMR, and Animal Naming. RESULTS The recently concussed group performed worse (P < .01 for all) on Stick Drop, total Wall Ball bounces and drops, and SMR compared with never-concussed and ever-concussed groups. This effect for Stick Drop, SMR, and Wall Ball but not Animal Naming persisted beyond the 4 weeks commonly stated to define recovery. Of 59 recently concussed subjects who returned for ≥1 visit, there were improvements in Stick Drop average (P = .004) and maxima (P = .02) as well as SMR (P = .01) but not Animal Naming between initial and subsequent visits. CONCLUSIONS This novel, rapid testing battery distinguished groups of children ages 10-18 years who had and had not experienced a recent concussion. A view that physical concussion symptoms resolve within a month of injury may be incomplete. Deployment of this readily available, inexpensive and non-proprietary battery should be compared with other tools and studied further in serial assessments.
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Affiliation(s)
- William D Brown
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI; Department of Neurology, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI.
| | - Janette Baird
- Department of Emergency Medicine, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI
| | - Peter K Kriz
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI; Department of Orthopedics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI
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15
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Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management. J Pediatr 2020; 223:128-135. [PMID: 32507622 PMCID: PMC7419017 DOI: 10.1016/j.jpeds.2020.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/11/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes. STUDY DESIGN A single-institution retrospective cohort study using electronic health record data from children ages 5- to 11 years with a concussion from July 1, 2014, through June 30, 2015. Electronic health record data were abstracted for a 20% random sample of 292 patients. RESULTS Three-fourths of patients (74.3%) presenting for concussion care had a standardized visiovestibular assessment performed. Almost all of those who eventually sought specialty care (92.9%) also had such an assessment, and only 42.9% patients initially seen in the emergency department or urgent care were examined in this manner. Of those assessed, 62.7% (n = 136) demonstrated deficits, with children ages 9-11 years more frequently exhibiting deficits than their younger counterparts (67.9% vs 53.2%; P = .03). Almost all patients (95.9%) reported at least 1 somatic symptom (eg, headache, dizziness), and one-half to two-thirds reported problems with sleep (54.1%) and visiovestibular symptoms (66.1%). Only 11.6% of children were referred for rehabilitation therapies and less than one-half of concussed patients (43.8%) were provided with a letter recommending school accommodations. CONCLUSIONS Somatic symptoms, sleep problems, and visiovestibular deficits are common in elementary school-aged children with concussion, but specific visiovestibular clinical assessments are often not performed, particularly in the emergency department setting. Recommendations for school accommodations are often not provided at the time of concussion diagnosis. Incorporating a standardized visiovestibular assessment into practice could facilitate early targeted school accommodations and thereby improve return to learning for elementary school-aged children with concussion.
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Sarmiento K, Gioia GA, Kirkwood MW, Wade SL, Yeates KO. A commentary for neuropsychologists on CDC's guideline on the diagnosis and management of mild traumatic brain injury among children. Clin Neuropsychol 2020; 34:259-277. [PMID: 31530221 PMCID: PMC7039321 DOI: 10.1080/13854046.2019.1660806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/28/2019] [Accepted: 08/18/2019] [Indexed: 12/27/2022]
Abstract
Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline.Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline.Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices.Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.
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Affiliation(s)
- Kelly Sarmiento
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerard A. Gioia
- Division of Pediatric Neuropsychology, Children’s National Health System, George Washington University School of Medicine, Washington, DC, USA
| | - Michael W. Kirkwood
- Department of Physical Medicine and Rehabilitation, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Keith O. Yeates
- Departments of Psychology and Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Abstract
OBJECTIVES To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times. DESIGN Cross-sectional study. SETTING Two NCAA collegiate athletic facilities. INDEPENDENT VARIABLES Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination. MAIN OUTCOME MEASURES Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates. RESULTS Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = -4.018; 95% confidence interval (CI), -7.153 to -0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = -0.880, 95% CI, -1.731 to -0.029) and dual-task conditions (β = -2.225, 95% CI, -3.691 to -0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait. CONCLUSIONS Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait.
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Weissman B, Joseph M, Gronseth G, Sarmiento K, Giza CC. CDC's guideline on pediatric mild traumatic brain injury: Recommendations for neurologists. Neurol Clin Pract 2019; 9:241-249. [PMID: 31341712 DOI: 10.1212/cpj.0000000000000624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
Purpose of review In September 2018, the Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. Recent findings Based on a systematic review of the evidence that covers research published over a 25-year span (1990-2015), the CDC Pediatric mTBI Guideline strives to optimize the care of pediatric patients with mTBI. The guideline was developed using a rigorous methodology developed by the American Academy of Neurology. Summary Clinical practice recommendations in the CDC Pediatric mTBI Guideline can help guide neurologists with critical diagnostic and management decisions and to implement evidence-based strategies for the recovery of their young patients with this injury.
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Affiliation(s)
- Barbara Weissman
- Emory University School of Medicine (BW), Atlanta; University of Florida Health Science Center (MJ), Jacksonville; University of Kansas Medical Center (GG); Centers for Disease Control and Prevention (KS), Atlanta; and The University of California (CCG), Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA
| | - Madeline Joseph
- Emory University School of Medicine (BW), Atlanta; University of Florida Health Science Center (MJ), Jacksonville; University of Kansas Medical Center (GG); Centers for Disease Control and Prevention (KS), Atlanta; and The University of California (CCG), Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA
| | - Gary Gronseth
- Emory University School of Medicine (BW), Atlanta; University of Florida Health Science Center (MJ), Jacksonville; University of Kansas Medical Center (GG); Centers for Disease Control and Prevention (KS), Atlanta; and The University of California (CCG), Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA
| | - Kelly Sarmiento
- Emory University School of Medicine (BW), Atlanta; University of Florida Health Science Center (MJ), Jacksonville; University of Kansas Medical Center (GG); Centers for Disease Control and Prevention (KS), Atlanta; and The University of California (CCG), Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA
| | - Christopher C Giza
- Emory University School of Medicine (BW), Atlanta; University of Florida Health Science Center (MJ), Jacksonville; University of Kansas Medical Center (GG); Centers for Disease Control and Prevention (KS), Atlanta; and The University of California (CCG), Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA
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Oldham JR, Difabio MS, Kaminski TW, Dewolf RM, Howell DR, Buckley TA. Efficacy of Tandem Gait to Identify Impaired Postural Control after Concussion. Med Sci Sports Exerc 2019; 50:1162-1168. [PMID: 29315170 DOI: 10.1249/mss.0000000000001540] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely after concussion in collegiate student-athletes. In addition, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity. METHODS Seventy-six National Collegiate Athletic Association student-athletes performed TG and BESS tests: 38 acutely after concussion and 38 controls. Participants were tested at baseline (time 1) and again acutely after concussion, or the following year for controls (time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater minimal detectable change. A 2 × 2 mixed-design ANOVA compared each outcome variable. An receiver operating characteristic curve analysis was used to evaluate sensitivity, specificity, and area under the curve (AUC). RESULT There was a significant interaction (F = 8.757, P = 0.004) for TG whereby the concussion group was slower after concussion (10.59 ± 1.53 vs 11.80 ± 2.67 s), whereas there was no difference for controls (10.13 ± 1.72 vs 9.93 ± 1.85 s). There was no significant interaction for BESS (F = 0.235, P = 0.630) or mBESS (F = 0.007, P = 0.935). TG had a sensitivity of 0.632, a specificity of 0.605, and an AUC of 0.704. BESS had a sensitivity of 0.447, a specificity of 0.500, and an AUC of 0.508. mBESS had a sensitivity of 0.474, a specificity of 0.632, and an AUC of 0.535. CONCLUSIONS Participants completed TG significantly slower after concussion, whereas no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting postconcussion postural control assessments.
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Affiliation(s)
- Jessie R Oldham
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Melissa S Difabio
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.,Biomechanics and Movement Science, University of Delaware, Newark, DE
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Ryan M Dewolf
- Sports Concussion Clinic, MassGeneral Hospital for Children, Boston, MA
| | - David R Howell
- Sports Medicine Center, Colorado Children's Hospital, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.,Biomechanics and Movement Science, University of Delaware, Newark, DE
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20
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Goble DJ, Rauh MJ, Baweja HS. Normative Data for the BTrackS Balance Test Concussion-Management Tool: Results From 10 045 Athletes Aged 8 to 21 Years. J Athl Train 2019; 54:439-444. [PMID: 30870601 DOI: 10.4085/1062-6050-178-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Balance tests are a recommended assessment of motor function in concussion protocols. The BTrackS Balance Test (BBT) is a tool for concussion balance testing that uses low-cost force-plate technology to objectively measure postural sway. OBJECTIVE To provide normative data for the BBT in a large population of athletes. DESIGN Cross-sectional study. SETTING Concussion baseline testing at multiple facilities. PATIENTS OR OTHER PARTICIPANTS Male and female athletes (n = 10 045) ages 8 to 21 years. INTERVENTION(S) Athletes performed three 20-second trials of eyes-closed standing on the BTrackS Balance Plate with feet shoulder-width apart and hands on hips. MAIN OUTCOME MEASURE(S) Postural sway was measured as the average total center-of-pressure path length over 3 testing trials. RESULTS Postural sway was reduced (ie, balance improved) as athlete age increased and was less in female athletes than in male athletes. Percentile ranking tables were calculated based on sex and 2-year age groupings. CONCLUSIONS Our findings (1) provide context for BBT results performed in the absence of a baseline test, (2) can help mitigate athlete malingering, and (3) might identify individuals with latent neuromuscular injuries during baseline tests.
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Affiliation(s)
- Daniel J Goble
- School of Health Sciences, Department of Human Movement Science, Oakland University, Rochester, MI
| | - Mitchell J Rauh
- School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, San Diego State University, CA
| | - Harsimran S Baweja
- School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, San Diego State University, CA
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21
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Baseline Properties of the Sport Concussion Assessment Tool 3 (SCAT3) in Iranian Professional League Football Players. Asian J Sports Med 2017. [DOI: 10.5812/asjsm.58076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Babl FE, Dionisio D, Davenport L, Baylis A, Hearps SJC, Bressan S, Thompson EJ, Anderson V, Oakley E, Davis GA. Accuracy of Components of SCAT to Identify Children With Concussion. Pediatrics 2017; 140:peds.2016-3258. [PMID: 28771406 DOI: 10.1542/peds.2016-3258] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Sport Concussion Assessment Tool version 3 (SCAT3) and its child version (ChildSCAT3) are composite physical and neuropsychological scoring systems used to assess athletes after sport-related concussion. Based on limited validation data, we aimed to evaluate the ability of SCAT3 and ChildSCAT3 to differentiate children aged 5 to 16 years with concussion from controls. METHODS Prospective observational study of children in the emergency department with concussion (CONC group) and 2 control groups ([1] upper-limb injury [ULI] and [2] Well children) with equal-sized subgroups in 3 age bands of 5 to 8, 9 to 12, and 13 to 16 years. ChildSCAT3 was used for participants aged 5 to 12 years, and SCAT3 was used for participants aged 13 to 16 years. Differences between study groups were analyzed by using analysis of variance models, adjusting for age and sex. RESULTS We enrolled 264 children (90 CONC, 90 ULI, and 84 Well) in equal-sized age bands. The number and severity of child- and parent-reported symptom scores were significantly higher in the CONC group than either control group (P < .001). Mean double (ChildSCAT3 P < .001) and tandem stance errors (both P ≤ .01) were also significantly higher, and immediate memory was significantly lower for the CONC group (P < .01). No statistically significant group differences were found for orientation and digit backward tasks. There were no significant differences between ULI and Well control groups. CONCLUSIONS Overall, SCAT3 and ChildSCAT3 can differentiate concussed from nonconcussed patients, particularly in symptom number and severity.
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Affiliation(s)
- Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; .,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; and
| | - Diana Dionisio
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lucy Davenport
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amy Baylis
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Silvia Bressan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Emma J Thompson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; and
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; and
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurosurgery, Austin Health and Cabrini Hospital, Malvern, Victoria, Australia
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Brooks MA, Snedden TR, Mixis B, Hetzel S, McGuine TA. Establishing Baseline Normative Values for the Child Sport Concussion Assessment Tool. JAMA Pediatr 2017; 171:670-677. [PMID: 28492862 PMCID: PMC5710340 DOI: 10.1001/jamapediatrics.2017.0592] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/17/2017] [Indexed: 11/14/2022]
Abstract
Importance The Child Sport Concussion Assessment Tool (SCAT3) is a postconcussion sideline assessment tool measuring symptoms, cognition, and balance in preadolescent children. Minimal normative baseline data exist to aid decision making in clinical and athletic settings. Objective To collect normative baseline data for the Child SCAT3 in a large cohort of young athletes. Design, Setting, and Participants A cross-sectional study was conducted from May 31 to August 12, 2014, at various sporting events (basketball, soccer, baseball, and swimming) in Central Wisconsin among children 5 to 13 years of age who were English-speaking and did not report a lower leg injury within the past 2 months or a concussion within the past month. Data were analyzed between October 8, 2014, and September 12, 2016. Main Outcomes and Measures All Child SCAT3 components were assessed: child and parent report of symptom number and severity, cognition (Standardized Assessment of Concussion-child version [SAC-C]), and balance (modified Balance Error Scoring System [mBESS] and tandem gait). Summary statistics, mean differences, and effect sizes were calculated for each test component. Results Participants included 478 children (234 girls and 241 boys; mean [SD] age, 9.9 [1.9] years]) and their parents. Age had the largest effect on all Child SCAT3 components, with children 5 to 7 years of age reporting higher mean (SD) symptom severity scores compared with those 11 to 13 years of age (18.2 [10.0] vs 11.3 [9.0]; mean difference, 6.86 [95% CI, 4.22-9.50]; effect size, 0.74) and performing more poorly on the total SAC-C (mean [SD] score, 19.5 [5.1] vs 26.1 [2.1]; mean difference, -6.59 [95% CI, -7.49 to -5.68]; effect size, -2.1), mBESS (mean [SD] score, 1.67 [1.8] vs 0.76 [1.2]; mean difference, 0.91 [95% CI, 0.53-1.29]; effect size, 0.68), and tandem gait (mean [SD] time, 22.2 [8.3] vs 14.0 [3.7] seconds; mean difference, 8.23 seconds [95% CI, 6.63-9.82]; effect size, 1.55). Sex had a small effect on the mean (SD) number and severity of symptoms reported by the child (severity: boys, 15.1 [9.8] vs girls, 11.8 [9.2]; mean difference, 3.31 [95% CI, 1.60-5.02]; effect size, 0.35), mean (SD) number and severity of symptoms reported by the parent (severity: boys, 11.1 [7.7] vs girls, 9.4 [8.1]; mean difference, 1.63 [95% CI, 0.21-3.05]; effect size, 0.21), mean (SD) total SAC-C score (boys, 23.9 [3.9] vs girls, 24.9 [3.5]; mean difference, -0.92 [95% CI, -1.61 to -0.23]; effect size, -0.25), and mean (SD) mBESS score (boys, 1.21 [1.5] vs girls, 0.71 [1.0]; mean difference, 0.50 [95% CI, 0.27-0.74]; effect size, 0.38). Conclusions and Relevance Child SCAT3 baseline normative symptom, cognitive, and balance scores were different, with a large main effect for age and a small effect for sex. These findings may assist health care professionals with interpretation of Child SCAT3 scores for young athletes with a concussion in athletic and clinical settings.
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Affiliation(s)
- M. Alison Brooks
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison
| | | | - Benjamin Mixis
- School of Medicine and Public Health, University of Wisconsin–Madison
| | - Scott Hetzel
- Biostatistics and Medical Informatics, University of Wisconsin–Madison
| | - Timothy A. McGuine
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison
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