Acute Sport Concussion Assessment Optimization

A Prospective Assessment from the CARE Consortium

Care Consortium Investigators

Research output: Contribution to journalArticle

Abstract

Background: Numerous medical organizations recommend a multifaceted approach to the assessment of concussion occurring during sporting events. A number of tools are available to clinicians, with a wide breadth of sensitivity and specificity; however, little work has been done to evaluate the combined efficiency of these tools in concussed male and female athletes from a broad array of collegiate sports and with variable time from the pre-season baseline evaluation. Objective: The aim of this study was to optimize the concussion assessment battery for application within the first 72 h of injury, and to identify the necessary baseline retesting frequency. Methods: Between 2014 and 2017, a total of 1458 National Collegiate Athletic Association (NCAA) athletes sustaining 1640 diagnosed concussions completed a baseline assessment each year of the investigation and were evaluated up to three times within the first 72 h of injury using a standardized assessment protocol. Classification and regression tree analyses were implemented to identify the most efficient multifaceted assessment pathway to quantify concussion-related outcomes. Results were optimized for assessments occurring within 1 h post-injury, 1–24 h post-injury, and 24–72 h post-injury when using the raw post-injury assessment performance, difference scores from baseline evaluations occurring in the same year, and difference scores from baseline evaluations occurring the year prior. Results: At each of the assessment time points, the analyses indicated that alone or in combination, a symptom evaluation, Balance Error Scoring System (BESS) scores collected on the firm surface, and Standardized Assessment of Concussion (SAC) total score offered the best overall performance when compared with pre-morbid performance captured in the same season. Optimized sensitivity of the multifaceted approach was 61% within 1 h of injury, 67% at the 1–24 h interval, and 55% at the 24–72 h interval when difference scores from the same-season baseline were available. Conclusions: This investigation identified key concussion assessments in quantifying post-concussion performance among student athletes, that were maximized when same-season pre-morbid evaluations were available. Consistent with clinical recommendations, medical professionals should continue to focus on symptom reporting, postural control, and neurocognitive screening to support the clinical examination when making a concussion diagnosis.

Original languageEnglish (US)
JournalSports Medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Sports
Wounds and Injuries
Athletes
Symptom Assessment
Regression Analysis
Students
Sensitivity and Specificity

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Acute Sport Concussion Assessment Optimization : A Prospective Assessment from the CARE Consortium. / Care Consortium Investigators.

In: Sports Medicine, 01.01.2019.

Research output: Contribution to journalArticle

@article{5697e148801c43238080f6ca2d543beb,
title = "Acute Sport Concussion Assessment Optimization: A Prospective Assessment from the CARE Consortium",
abstract = "Background: Numerous medical organizations recommend a multifaceted approach to the assessment of concussion occurring during sporting events. A number of tools are available to clinicians, with a wide breadth of sensitivity and specificity; however, little work has been done to evaluate the combined efficiency of these tools in concussed male and female athletes from a broad array of collegiate sports and with variable time from the pre-season baseline evaluation. Objective: The aim of this study was to optimize the concussion assessment battery for application within the first 72 h of injury, and to identify the necessary baseline retesting frequency. Methods: Between 2014 and 2017, a total of 1458 National Collegiate Athletic Association (NCAA) athletes sustaining 1640 diagnosed concussions completed a baseline assessment each year of the investigation and were evaluated up to three times within the first 72 h of injury using a standardized assessment protocol. Classification and regression tree analyses were implemented to identify the most efficient multifaceted assessment pathway to quantify concussion-related outcomes. Results were optimized for assessments occurring within 1 h post-injury, 1–24 h post-injury, and 24–72 h post-injury when using the raw post-injury assessment performance, difference scores from baseline evaluations occurring in the same year, and difference scores from baseline evaluations occurring the year prior. Results: At each of the assessment time points, the analyses indicated that alone or in combination, a symptom evaluation, Balance Error Scoring System (BESS) scores collected on the firm surface, and Standardized Assessment of Concussion (SAC) total score offered the best overall performance when compared with pre-morbid performance captured in the same season. Optimized sensitivity of the multifaceted approach was 61{\%} within 1 h of injury, 67{\%} at the 1–24 h interval, and 55{\%} at the 24–72 h interval when difference scores from the same-season baseline were available. Conclusions: This investigation identified key concussion assessments in quantifying post-concussion performance among student athletes, that were maximized when same-season pre-morbid evaluations were available. Consistent with clinical recommendations, medical professionals should continue to focus on symptom reporting, postural control, and neurocognitive screening to support the clinical examination when making a concussion diagnosis.",
author = "{Care Consortium Investigators} and Broglio, {Steven P.} and Jaroslaw Harezlak and Barry Katz and Shi Zhao and Thomas McAllister and Michael McCrea and Joseph Hazzard and Louise Kelly and Darren Campbell and Jonathan Jackson and Gerald McGinty and Patrick O’Donnell and Kenneth Cameron and Adam Susmarski and Josh Goldman and Christopher Giza and Thomas Buckley and Thomas Kaminski and James Clugston and Julianne Schmidt and Luis Feigenbaum and Eckner, {James T.} and Scott Anderson and Christina Master and Anthony Kontos and Sara Chrisman and Alison Brooks",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s40279-019-01155-0",
language = "English (US)",
journal = "Sports Medicine",
issn = "0112-1642",
publisher = "Springer International Publishing AG",

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TY - JOUR

T1 - Acute Sport Concussion Assessment Optimization

T2 - A Prospective Assessment from the CARE Consortium

AU - Care Consortium Investigators

AU - Broglio, Steven P.

AU - Harezlak, Jaroslaw

AU - Katz, Barry

AU - Zhao, Shi

AU - McAllister, Thomas

AU - McCrea, Michael

AU - Hazzard, Joseph

AU - Kelly, Louise

AU - Campbell, Darren

AU - Jackson, Jonathan

AU - McGinty, Gerald

AU - O’Donnell, Patrick

AU - Cameron, Kenneth

AU - Susmarski, Adam

AU - Goldman, Josh

AU - Giza, Christopher

AU - Buckley, Thomas

AU - Kaminski, Thomas

AU - Clugston, James

AU - Schmidt, Julianne

AU - Feigenbaum, Luis

AU - Eckner, James T.

AU - Anderson, Scott

AU - Master, Christina

AU - Kontos, Anthony

AU - Chrisman, Sara

AU - Brooks, Alison

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Numerous medical organizations recommend a multifaceted approach to the assessment of concussion occurring during sporting events. A number of tools are available to clinicians, with a wide breadth of sensitivity and specificity; however, little work has been done to evaluate the combined efficiency of these tools in concussed male and female athletes from a broad array of collegiate sports and with variable time from the pre-season baseline evaluation. Objective: The aim of this study was to optimize the concussion assessment battery for application within the first 72 h of injury, and to identify the necessary baseline retesting frequency. Methods: Between 2014 and 2017, a total of 1458 National Collegiate Athletic Association (NCAA) athletes sustaining 1640 diagnosed concussions completed a baseline assessment each year of the investigation and were evaluated up to three times within the first 72 h of injury using a standardized assessment protocol. Classification and regression tree analyses were implemented to identify the most efficient multifaceted assessment pathway to quantify concussion-related outcomes. Results were optimized for assessments occurring within 1 h post-injury, 1–24 h post-injury, and 24–72 h post-injury when using the raw post-injury assessment performance, difference scores from baseline evaluations occurring in the same year, and difference scores from baseline evaluations occurring the year prior. Results: At each of the assessment time points, the analyses indicated that alone or in combination, a symptom evaluation, Balance Error Scoring System (BESS) scores collected on the firm surface, and Standardized Assessment of Concussion (SAC) total score offered the best overall performance when compared with pre-morbid performance captured in the same season. Optimized sensitivity of the multifaceted approach was 61% within 1 h of injury, 67% at the 1–24 h interval, and 55% at the 24–72 h interval when difference scores from the same-season baseline were available. Conclusions: This investigation identified key concussion assessments in quantifying post-concussion performance among student athletes, that were maximized when same-season pre-morbid evaluations were available. Consistent with clinical recommendations, medical professionals should continue to focus on symptom reporting, postural control, and neurocognitive screening to support the clinical examination when making a concussion diagnosis.

AB - Background: Numerous medical organizations recommend a multifaceted approach to the assessment of concussion occurring during sporting events. A number of tools are available to clinicians, with a wide breadth of sensitivity and specificity; however, little work has been done to evaluate the combined efficiency of these tools in concussed male and female athletes from a broad array of collegiate sports and with variable time from the pre-season baseline evaluation. Objective: The aim of this study was to optimize the concussion assessment battery for application within the first 72 h of injury, and to identify the necessary baseline retesting frequency. Methods: Between 2014 and 2017, a total of 1458 National Collegiate Athletic Association (NCAA) athletes sustaining 1640 diagnosed concussions completed a baseline assessment each year of the investigation and were evaluated up to three times within the first 72 h of injury using a standardized assessment protocol. Classification and regression tree analyses were implemented to identify the most efficient multifaceted assessment pathway to quantify concussion-related outcomes. Results were optimized for assessments occurring within 1 h post-injury, 1–24 h post-injury, and 24–72 h post-injury when using the raw post-injury assessment performance, difference scores from baseline evaluations occurring in the same year, and difference scores from baseline evaluations occurring the year prior. Results: At each of the assessment time points, the analyses indicated that alone or in combination, a symptom evaluation, Balance Error Scoring System (BESS) scores collected on the firm surface, and Standardized Assessment of Concussion (SAC) total score offered the best overall performance when compared with pre-morbid performance captured in the same season. Optimized sensitivity of the multifaceted approach was 61% within 1 h of injury, 67% at the 1–24 h interval, and 55% at the 24–72 h interval when difference scores from the same-season baseline were available. Conclusions: This investigation identified key concussion assessments in quantifying post-concussion performance among student athletes, that were maximized when same-season pre-morbid evaluations were available. Consistent with clinical recommendations, medical professionals should continue to focus on symptom reporting, postural control, and neurocognitive screening to support the clinical examination when making a concussion diagnosis.

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