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Sik A, Kaveney‐Gibb B, Cooper J, Pearson J, Larsen P, Rogan A. Is the Sport Concussion Assessment Tool 5th Edition a useful concussion assessment tool in head‐injured patients presenting to the emergency department? Emerg Med Australas 2022; 35:474-482. [PMID: 36529471 DOI: 10.1111/1742-6723.14144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Concussion is a common ED complaint, but diagnosis is challenging as there are no validated objective measures. Use of concussion tools derived from sports medicine is common, but these tools are not well validated in ED settings. The aim of this study was to assess the ability of the Sport Concussion Assessment Tool 5th Edition (SCAT5) to identify concussion in ED patients presenting following head injury. METHODS We conducted a prospective observational study of head-injured adult patients presenting to ED between March and July 2021. ED diagnosis of concussion was used as the diagnostic standard, and we assessed the diagnostic performance of the SCAT5 test and its three subsections (Standardised Assessment of Concussion (SAC), Post-Concussion Symptom Scale (PCSS) and Modified Balance Error Scoring System (mBESS)) against this. RESULTS Thirty-two head-injured participants were enrolled, 19 of whom had a discharge diagnosis of concussion, alongside 17 controls. Median time for SCAT5 testing was 21 (interquartile range 16-27) min. Fifteen (30.6%) participants were interrupted during testing. Area under the curve (AUC) (95% confidence interval) for the SAC, PCSS and mBESS were 0.51 (0.34-0.68), 0.92 (0.84-0.99) and 0.66 (0.47-0.85), respectively. Sensitivity and specificity of sections were as follows: entire SCAT5 (100.0%, 20.0%), SAC (48.1%, 60.0%), PCSS (89.7%, 85.0%) and mBESS (83.3%, 58.8%). Using PCSS alone would have identified 17 of 19 concussions. CONCLUSION The SCAT5 test had a low specificity, was long and was frequently interrupted. We suggest it is not an ideal assessment to use in ED. The PCSS score performed well and was easy to complete. It may be useful as a standalone tool to simplify ED concussion identification.
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Affiliation(s)
- Annabelle Sik
- Department of Surgery and Anaesthesia University of Otago Wellington New Zealand
| | - Ben Kaveney‐Gibb
- Department of Surgery and Anaesthesia University of Otago Wellington New Zealand
| | - James Cooper
- Department of Surgery and Anaesthesia University of Otago Wellington New Zealand
| | - Jake Pearson
- Department of Surgery and Anaesthesia University of Otago Wellington New Zealand
| | - Peter Larsen
- Department of Surgery and Anaesthesia University of Otago Wellington New Zealand
| | - Alice Rogan
- Department of Surgery and Anaesthesia University of Otago Wellington New Zealand
- Wellington Emergency Department Wellington Regional Hospital Wellington New Zealand
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Sports-Related Concussion Is a Personalized Issue—Evaluation of Medical Assessment and Subjective Feeling of the Athlete in a German Level 1 Trauma Center. J Pers Med 2022; 12:jpm12101596. [PMID: 36294735 PMCID: PMC9605563 DOI: 10.3390/jpm12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
Sports-related concussions (SRC) have developed into a highly discussed topic in sports medicine over the last few years and demonstrate a severe issue in the personalized treatment of patients. This retrospective cohort study investigated 86 patients with sports-related concussions in a level 1 trauma center, relating to the mechanism, symptoms, medical history, acute therapy including first assessment and the return to sport. The research is based on medical records as well as questionnaires six months after hospitalization. Loss of consciousness for under 30 min (41.2%), headache (36.5%) and amnesia (29.4%) were the most frequent symptoms when presenting in the emergency room. During the hospitalization, mainly headache and vertigo were documented. Most concussions occurred after incidents in equitation and cycling sports; the most common mechanism was falling to the ground with a subsequent impact (59.3%). At the time of discharge from hospital, in 13.4% of all cases, concussion symptoms were still documented in medical records, in contrast to 39.5% of the concerned athletes who reported symptoms for longer than 24 h, and 41.0% who reported ongoing post-concussion symptoms after six months. Concussions are difficult-to-treat disorders with a challenging diagnostic process and many symptoms in various values and levels of persistence. Therefore, a patient-involving treatment with a complaint-dependent return to sport process should be applied to concerned athletes.
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Toman E, Riley M, Hodgson S, Yakoub KM, Cooper L, Bishop J, Naumann DN, Welbury R, Hammond D, Di Pietro V, Belli A. Concussion in Non-athletes: Assessment of Cognition and Symptomatology (CONTACTS) study protocol - an exploratory cohort study investigating the utility of sports concussion assessment tools and salivary microRNAs to diagnose concussion in NHS patients. BMJ Open 2022; 12:e062030. [PMID: 36130754 PMCID: PMC9494594 DOI: 10.1136/bmjopen-2022-062030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Concussion is a complex pathophysiological process with a wide range of non-specific signs and symptoms. There are currently no objective diagnostic tests to identify concussion, and diagnosis relies solely on history and examination. Recent research has identified a unique panel of microRNAs (miRNAs) that distinguish between concussed and non-concussed rugby players. This study aims to assess the diagnostic utility of salivary miRNAs in concussion for a sample of UK National Health Service patients and whether well-established sports-related concussion (SRC) assessment tools may be translated into the emergency department (ED). METHODS AND ANALYSIS Concussion in Non-athletes: Assessment of Cognition and Symptomatology is a single-centre, prospective, two-phase cohort study. The concussed cohort will consist of participants with maxillofacial trauma and concurrent concussion. The control cohort will consist of participants with isolated limb trauma and no evidence of concussion. Participants will be recruited in the ED and saliva samples will be taken to identify the presence of miRNAs. The SRC assessments being investigated include the Sports Concussion Assessment Test, Fifth Edition (SCAT5), the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the ImPACT Quick. Follow-up will be at 24-48 hours in-hospital and remotely via telephone and email at 14 days and 6 months. ETHICS AND DISSEMINATION Ethical approval was granted in February 2021 by the West Midlands Coventry & Warwickshire Research Ethics Committee (ref 20/WM/0299). The investigators intend to submit their study findings for publication in peer-reviewed journals and to disseminate study findings via presentation at academic meetings. The results will also form part of a doctorate thesis, registered at the University of Birmingham.
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Affiliation(s)
- Emma Toman
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Max Riley
- Medical School, University of Birmingham, Birmingham, UK
| | - Sam Hodgson
- Medical School, University of Birmingham, Birmingham, UK
| | - Kamal M Yakoub
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lauren Cooper
- Research and Development, University Hospitals Birmingham, Birmingham, UK
| | - Jon Bishop
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David N Naumann
- Royal Centre for Defence Medicine, Birmingham, UK
- Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Welbury
- School of Dentistry, University of Central Lancashire, Preston, UK
| | - Douglas Hammond
- Department of Oral and Maxillofacial Surgery, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Valentina Di Pietro
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Antonio Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Mohai A, Gifford J, Herkt R, Parker A, Toder A, Dixon D, Kennedy E. A scoping review of cervical spine evaluation in standardised clinical concussion evaluation tools. Phys Ther Sport 2022; 57:95-104. [PMID: 35963133 DOI: 10.1016/j.ptsp.2022.07.010] [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: 03/15/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND It can be a challenge for clinicians to evaluate trauma that could represent cervical spine injury, concussion, or both. These conditions share common mechanisms of injury and symptom profiles, yet distinct aetiology and management. In the clinical evaluation of concussion, a range of standardised tools are available but the extent to which such tools include cervical spine evaluation is unclear. OBJECTIVE To identify a variety of standardised clinical concussion evaluation tools, examine if these tools include cervical spine evaluation, and describe the characteristics of cervical spine evaluation included. To have an informed discussion about how cervical spine evaluation might best be approached after a concussion event. DESIGN Scoping review. METHOD A structured literature search was performed in eight databases to identify standardised clinical concussion evaluation tools. Each tool was then reviewed for cervical spine evaluation, and the characteristics of tools including cervical spine evaluation were described. RESULTS The structured search identified 82 standardised clinical concussion evaluation tools. Eleven tools included cervical spine assessment related primarily to the evaluation of red flags and symptoms, just three included physical examination. CONCLUSION Few standardised clinical concussion evaluation tools include cervical spine evaluation, and even fewer include physical examination. Cervical spine evaluation in concussion may benefit from closer alignment with established approaches to screening for clinically significant cervical spine injuries. In concussion, we advocate for an approach to cervical spine evaluation that includes screening for dangerous mechanisms of injury, neurological deficit, distracting injury and neck pain; and physical examination of neck range of motion and neck tenderness.
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Affiliation(s)
| | - Jack Gifford
- School of Physiotherapy, University of Otago, New Zealand
| | - Rebecca Herkt
- School of Physiotherapy, University of Otago, New Zealand
| | - Alexia Parker
- School of Physiotherapy, University of Otago, New Zealand
| | - Aiden Toder
- School of Physiotherapy, University of Otago, New Zealand
| | - Dave Dixon
- Southern District Health Board, New Zealand
| | - Ewan Kennedy
- School of Physiotherapy, University of Otago, New Zealand
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Shaikh N, Tokhi Y, Hardaker N, Henshall K, Forch K, Fernando K, King D, Fulcher M, Jewell S, Bastos-Gottgtroy R, Hume P, Theadom A. Brain Injury Screening Tool (BIST): test-retest reliability in a community adult sample. BMJ Open 2022; 12:e057701. [PMID: 35922098 PMCID: PMC9352980 DOI: 10.1136/bmjopen-2021-057701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the test-retest reliability of the Brain Injury Screening Tool (BIST), which was designed to support the initial assessment of mild traumatic brain injury (mTBI) across a variety of contexts, including primary and secondary care. DESIGN Test-retest design over a 2-week period. SETTING Community based. PARTICIPANTS Sixty-eight adults (aged 18-58 years) who had not experienced an mTBI within the last 5 years and completed the BIST on two different occasions. MEASURES Participants were invited to complete the 15-item BIST symptom scale and the Depression, Anxiety and Stress Scale (DASS-21) online at two time-points (baseline and 2 weeks later). To account for large variations in mood affecting symptom reporting, change scores on the subscales of the DASS-21 were calculated, and outliers were removed from the analysis. RESULTS The BIST total symptom score and subscale scores (physical-emotional, cognitive and vestibular) demonstrated moderate to good test-retest reliability with intraclass correlation coefficients ranging between 0.51 and 0.83. There were no meaningful differences between symptom reporting on the total scale or subscales of the BIST between time1 and time2 at the p<0.05 level when calculated using related samples Wilcoxon signed-rank tests. CONCLUSION The BIST showed evidence of good stability of symptom reporting within a non-injured, community adult sample. This increases confidence that changes observed in symptom reporting in an injured sample are related to actual symptom change rather than measurement error and supports the use of the symptom scale to monitor recovery over time. Further research is needed to explore reliability of the BIST within those aged <16 years.
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Affiliation(s)
- Nusratnaaz Shaikh
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Yelda Tokhi
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Hardaker
- Accident Compensation Corporation, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Kevin Henshall
- Trauma Service, Counties Manukau Health, Auckland, New Zealand
| | - Katherine Forch
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Axis Sports Medicine, Auckland, New Zealand
| | | | - Doug King
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK
| | | | - Sam Jewell
- Wellington Sports Medicine, Wellington, New Zealand
| | - Renata Bastos-Gottgtroy
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Coscia A, Stolz U, Barczak C, Wright N, Mittermeyer S, Shams T, Epstein S, Kreitzer N. Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease. J Head Trauma Rehabil 2021; 36:E302-E311. [PMID: 33656471 DOI: 10.1097/htr.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Sports Concussion Assessment Tool 3 (SCAT3) Symptom Evaluation (SE) is used in the emergency department (ED). This study aimed to examine the effects of psychiatric history on the SCAT3 SE symptom severity score (SSS). SETTING Three US EDs. PARTICIPANTS A total of 272 ED patients with suspected concussion. DESIGN Prospective, nonrandomized, nonblinded study. The SCAT3 SE SSS, demographic data, medical information, and self-reported psychiatric history were obtained from patients by clinical research staff when they presented to the ED seeking standard clinical care. Concussion diagnoses were determined following a comprehensive assessment by an ED physician trained in managing concussions and adjudicated by supervising physicians. MAIN MEASURES The primary outcome measure was SSS. The association between SSS, self-reported psychiatric disease, and concussion diagnosis was analyzed using multivariable linear regression. RESULTS 68.4% of subjects were diagnosed with a concussion. After controlling for age, sex, race, history of previous concussion, and interval from injury to ED presentation, self-reported psychiatric history (adjusted regression coefficient (βa): 16.9; confidence interval [CI]: 10.1, 23.6), and concussion diagnosis (βa: 21.7; CI: 14.2, 29.2) were both independently associated with a significant increase in SSS. Subjects with a history of concussion had a significantly higher SSS (βa: 9.1; CI: 1.8, 16.5). Interval from injury to ED presentation was also associated with a significant increase in SSS (βa: 1.6 per 6-hour increase; CI: 0.4, 2.8). CONCLUSION Our findings demonstrate that a history of preexisting psychiatric disease, as self-reported by patients with a suspected concussion treated in the ED, is independently associated with significantly higher scores on the SCAT3 SE. This suggests that a history of psychiatric illness may need to be accounted for when the SCAT3 SE is used in the ED for the assessment of concussion.
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Affiliation(s)
- Atticus Coscia
- Department of Emergency Medicine, University of Cincinnati Medical Center, Ohio (Messrs Coscia and Barczak and Drs Stolz and Kreitzer); Jan Medical, Mountain View, California (Ms Wright and Dr Mittermeyer); Ballad Health, Johnson City, Tennessee (Dr Shams); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Dr Epstein); and Division of Neurocritical Care, University of Cincinnati Medical Center, Ohio (Dr Kreitzer)
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Bunt SC, Didehbani N, LoBue C, Stokes M, Heinzelmann M, Rossetti H, Miller SM, Nakonezny PA, Bell K, Batjer H, Cullum CM. Sex differences in reporting of concussion symptoms in adults. Clin Neuropsychol 2020; 36:1290-1303. [PMID: 33258703 DOI: 10.1080/13854046.2020.1842500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine differences in concussion symptom reporting between female and male adults considering current psychological symptoms such as anxiety and depression and pre-injury factors in order to identify sex differences which may guide treatment efforts. Method: This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N = 132) age 19 to 78 years had sustained a concussion within 30 days of clinic visit. The independent variable was sex and covariates included age, ethnicity, current anxiety and depression ratings, history of attention deficit disorder, history of headache/migraine, and time to clinic. The dependent variables were 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool-5 Post-Concussion Symptom Scale. Results: Analysis of covariance and ordinal logistic regression results both revealed that females had a greater likelihood of reporting increased symptom severity for 15/22 concussion symptoms. The largest risk ratios (effect size) in symptom reporting between sexes (higher symptoms in females) included: feeling more emotional 4.05 (0.72), fatigue or low energy 4.05 (0.72), sensitivity to light 3.74 (0.69), headache 3.65 (0.57), balance problems 3.31 (0.53), pressure in head 3.06 (0.51), and neck pain 2.97 (0.60). Conclusions: Adult females in our sample reported higher levels of many concussion symptoms than males and showed an increased risk of developing these same symptoms following concussion. Examination of the magnitude of sex difference in concussion symptom reporting will better inform medical staff to anticipate and address symptoms that may present greater challenges for adult females.
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Affiliation(s)
- Stephen C Bunt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Stokes
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Morgan Heinzelmann
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Heidi Rossetti
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shane M Miller
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Orthopedics, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.,Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Paul A Nakonezny
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hunt Batjer
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
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