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.
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.
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.
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.
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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The authors would like to thank April Reed Hoy (Azusa Pacific University), Justus Ortega (Humboldt State University), Nicholas Port (Indiana University), Margot Putukian (Princeton University), Dianne Langford and Ryan Tierney (Temple University), Holly Benjamin (University of Chicago), Kevin Guskiewicz and Jason Mihalik (University of North Carolina–Chapel Hill), Jessica Miles (University of North Georgia), Jeffrey Bazarian (University of Rochester), Stefan Duma (Virginia Tech), Christopher Bullers and Christopher Miles (Wake Forest University), Brian Dykhuizen (Wilmington College), Laura Lintner (Winston-Salem State University), Paul Pasquina (Uniformed Services University), Jody Harland, Janetta Matesan, and Larry Riggen (Indiana University), Ashley Rettmann (University of Michigan), Melissa Koschnitzke (Medical College of Wisconsin), Michael Jarrett, Vibeke Brinck, and Bianca Byrne (Quesgen), Thomas Dompier, Christy Collins, Melissa Niceley Baker, and Sara Dalton (Datalys Center for Sports Injury Research and Prevention), and the research and medical staff at each of the participating sites.
This publication was made possible, in part, by support from the Grand Alliance CARE Consortium, funded by the NCAA and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014, USA, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14-2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).
Conflicts of interest
Steven Broglio, Jaroslaw Harezlak, Barry Katz, Shi Zhao, Thomas McAllister, and Michael McCrea received funding from the NCAA and the Department of Defense to complete this investigation and to cover travel costs related to the study.
The members of CARE Consortium Investigators are listed in “Appendix”.
This article is part of a Topical Collection on The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium.
CARE Consortium Investigators are listed alphabetically by institution: Joseph Hazzard (Bloomsburg University), Louise Kelly (California Lutheran University), Darren Campbell, Jonathan Jackson, and Gerald McGinty (US Air Force Academy), Patrick O’Donnell (US Coast Guard Academy), Kenneth Cameron (US Military Academy), Adam Susmarski (US Naval Academy), Josh Goldman and Christopher Giza (University of California–Los Angeles), Thomas Buckley and Thomas Kaminski (University of Delaware), James Clugston (University of Florida), Julianne Schmidt (University of Georgia), Luis Feigenbaum (University of Miami), James T. Eckner (University of Michigan), Scott Anderson (University of Oklahoma), Christina Master (University of Pennsylvania), Anthony Kontos (University of Pittsburgh), Sara Chrisman (University of Washington), and Alison Brooks (University of Wisconsin).
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Broglio, S.P., Harezlak, J., Katz, B. et al. Acute Sport Concussion Assessment Optimization: A Prospective Assessment from the CARE Consortium. Sports Med 49, 1977–1987 (2019). https://doi.org/10.1007/s40279-019-01155-0