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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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Trbovich AM, Mucha A, Zynda AJ, Farley T, Kegel N, Fazio V, Collins MW, Kontos AP. Multidomain Predictors of Protracted Recovery following Concussion among 5- to 9-Year-Old Patients: A Preliminary Study. J Pediatr 2024; 268:113927. [PMID: 38309522 DOI: 10.1016/j.jpeds.2024.113927] [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: 11/09/2023] [Revised: 01/09/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion. STUDY DESIGN A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion to a specialty clinic were categorized into normal (≤30 days) and protracted (>30 days) recovery. Participants provided demographic and medical history information, and completed the Child Sport Concussion Assessment Tool-5 symptom report and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing. Univariate logistic regressions (LR) were used to inform a follow-up forward stepwise LR to identify the best predictors of protracted recovery. Receiver operating characteristic analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best discriminated recovery. RESULTS The final sample included 68 patients (7.52 ± 2.3 years; 56% male), 36 (52.9%) with normal and 32 (47.1%) with protracted recovery. Results of the LR to identify protracted recovery were significant (P < .001) and accounted for 39% of the variance. The model accurately classified 78% of patients, with days to first clinic visit (OR, 1.2; 95% CI, 1.1-1.4; P = .003) and positive VOMS-C findings (OR, 8.32; 95% CI, 2.4-28.8; P < .001) as significant predictors. A receiver operating characteristic analysis of the AUC of this 2-factor model discriminated protracted from normal recovery (AUC, 0.82; 95% CI, 0.71-0.92; P < .001). CONCLUSIONS Days to first clinic visit and positive findings on the VOMS-C were the most robust predictors of protracted recovery after concussion in young pediatric patients.
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Affiliation(s)
- Alicia M Trbovich
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA.
| | - Anne Mucha
- University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA
| | - Aaron J Zynda
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Taylor Farley
- University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA
| | - Nathan Kegel
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Vanessa Fazio
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Michael W Collins
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
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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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Hou X, Zhang Y, Fei X, Zhou Q, Li J. Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3604-3618. [PMID: 36799499 DOI: 10.1177/03635465221142855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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Trbovich AM, Fazio-Sumrok V, Preszler J, Shaffer MA, Kegel N, Kissinger-Knox A, Collins MW, Kontos AP. Discriminating Young Children with Concussion in an Outpatient Specialty Clinic from Healthy Controls Using the Child SCAT5. J Pediatr 2023:113380. [PMID: 36889630 DOI: 10.1016/j.jpeds.2023.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To evaluate the clinical utility of the Child SCAT5 in an outpatient specialty clinic sample of children ages 5-9. STUDY DESIGN Ninety-six children within 30 days of a concussion (M=8.90+5.78 days) and 43 age and sex-matched healthy controls completed the Child SCAT5, including balance items, cognitive screening, parent and child symptom and severity reports, as well as each individual parent- and child-rated symptom severity (0-3). A series of receiver operating characteristic (ROC) curves with area under the curve (AUC) analysis were performed to evaluate the clinical utility of the Child SCAT5 components to discriminate concussion. RESULTS The AUC values were non-discriminate for cognitive screening (.32) and poor for balance (.61) items. The AUC values were acceptable for parent-reported symptoms worsening after physical activity (.73) and mental activity (.72). The AUCs for symptom severity items were excellent for parent (.89) and child-reported (.81) headaches, and were acceptable for parent-reported tired a lot (.75), and both parent (.72) and child-reported (.72) tired easily. CONCLUSION With the exception of parent and child-reported symptoms, the Child SCAT5 provides limited clinical utility for evaluating concussion in children aged 5-9 years seen at an outpatient concussion specialty clinic. The cognitive screening and balance testing items were not useful in discriminating concussion. Parent and child-reported headache were the only Child SCAT5 items with excellent ability to differentiate concussion from controls in the age group.
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Affiliation(s)
- Alicia M Trbovich
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA.
| | | | - Jonathan Preszler
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Madelyn A Shaffer
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Nathan Kegel
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Michael W Collins
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
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Footwear Type and Testing Environment Do Not Affect Baseline Modified Balance Error Scoring System Performance Among Middle School Athletes. J Sport Rehabil 2023; 32:9-13. [PMID: 35894918 DOI: 10.1123/jsr.2021-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Limited evidence exists to demonstrate the effect of extrinsic factors, such as footwear worn or the testing environment, on performance of the modified balance error scoring system (mBESS) in the middle school age (10-14 y) population. Therefore, the purpose of our study was to investigate the effect of footwear types and testing environments on performance of the mBESS by middle school athletes. DESIGN Cross-sectional. METHODS In total, 2667 middle school athletes (55.9% boys and 44.1% girls; age = 12.3 [0.94] y) were administered the mBESS while wearing their self-selected footwear (barefoot, cleats, or shoes) either indoors (basketball court) or outdoors (football field or track). The number of errors committed (range = 0-10) during the double-leg, single-leg, and tandem stances of the mBESS were summed to calculate a total score (range = 0-30). Kruskal-Wallis tests were used to assess for differences among the footwear groups for each mBESS stance and the total score. Mann-Whitney U tests with calculated nonparametric effect sizes (r) were used to assess for differences between the footwear groups and testing environments when appropriate. RESULTS There were significant differences for the number of committed errors among the footwear groups in the single-leg (P < .001) and tandem (P < .001) stances of the mBESS and mBESS total scores (P < .001). Significantly fewer errors (better) were committed while wearing shoes compared with other footwear in the single-leg and tandem stances of the mBESS (Ps ≤ .032, r = .07-.13). Participants assessed indoors committed significantly fewer errors than those assessed outdoors in each stance of the mBESS (Ps ≤ .022, r = .04-.14). Lower (better) mBESS total scores were observed for participants while wearing shoes (Ps ≤ .002, r = .10-.15) or assessed indoors (P = .001, r = .14). CONCLUSIONS Although our data suggest that the type of footwear worn and the testing environment have a significant effect on mBESS scores of middle school athletes, the magnitudes of these differences are negligible.
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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, 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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