Sports Medicine Research: In the Lab & In the Field: If You’re Not Using the SCAT-2 For On-Field Concussion Diagnosis Maybe You Should Be (Sports Med Res)
Wednesday, July 9, 2014

If You’re Not Using the SCAT-2 For On-Field Concussion Diagnosis Maybe You Should Be

Prospective Clinical Assessment Using Sideline Concussion Assessment Tool-2 Testing in Evaluation of Sport-Related Concussion in College Athletes

Putukian M., Echemendia R., Dettwiler-Danspeckgruber Duliba T., Bruce J., Furtado JL., Murugavel M. Clin J Sport Med. 2014: ahead of print.

Take Home Message: The SCAT-2 tool composite score is useful in sports-related concussion assessment in a college setting due to its high sensitivity and specificity especially if you can compare a post injury score with a baseline measure.

Medical personnel use acute concussion assessment sideline tools, such as the SCAT-2, to make on-field decisions; however, the sensitivity and specificity of the SCAT-2 with and without baseline SCAT-2 measures are unclear. For medical personnel to determine an on-field concussion prognosis we need to know the accuracy (i.e., sensitivity & specificity) of the SCAT-2 concussion assessment tool. Therefore, the authors evaluated the utility of the SCAT-2 (with and without baseline testing) for the assessment of sports-related concussion in college athletes. They also assessed potential modifiers that could influence SCAT-2 scores (age, sex, history of concussion, loss of consciousness, depression & anxiety). The authors included 263 college athletes with baseline SCAT-2 scores (68% male; on average 20 years of age; 78 had no history of concussion; 233 had reported no loss of consciousness). Among these athletes, 32 athletes sustained a concussion and completed the post-test SCAT-2 within 2 days of the concussive injury. Non-concussed contact sport athletes served as the controls and repeated SCAT-2 testing at 3 to 6 months after their baseline testing. The authors found that athletes who endorsed depression or anxiety symptoms (measured with Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively) during baseline testing demonstrated worse concussion-related symptom severity and more symptoms according to the baseline SCAT-2 screening. None of the other modifiers (age, sex, history of concussion or loss of consciousness) were associated with baseline SCAT-2 performance. Athletes who sustained a concussion scored worse than their control counterparts on each subcomponent of the SCAT-2 retest (i.e., SCAT-2 total, symptom severity, total symptoms & balance total). The authors determined that with comparison with a baseline measurement a 3.5 point drop in SCAT-2 score has 96% sensitivity and 81% specificity, while without a baseline measurement (using the normative cutoff of 74.5) the sensitivity is 83% and specificity is 91%.

This study demonstrates the utility of the SCAT-2 in a college population to assess acute sport-related concussions. The total SCAT-2, total symptom score, total symptoms, and modified BESS (only using firm stances) were all worse post injury compared with baseline scores. The Standardized Assessment of Concussion was not different in the concussed group post injury compared with their baseline; however, they performed worse than their uninjured peers who improved when they repeated the testing. The SCAT-2 had high sensitivity and moderate specificity whether there was a baseline measurement or not. However, with a baseline comparison sensitivity is higher, which is clinically important since it ensures that concussed athletes are managed conservatively. Given the expense and difficulties, conducting computerized neurocognitive exams the utility of the SCAT-2 should be carefully evaluated at each school. It should be noted that they only assessed the SCAT-2 at one acute concussion time point; hence, we cannot determine the utility of the SCAT-2 for return to play management. However, this study demonstrates that medical personnel should be confident using the SCAT-2 as part of their concussion assessment protocol when diagnosing an acute sport-related concussion even if they are lacking baseline testing.

Questions for Discussion: Do you prefer to use SCAT-2 over computerized neurocognitive testing? Do you use the SCAT-2 to determine when an athlete can return to play? Do you baseline test your athletes using the SCAT-2?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:


Putukian M, Echemendia R, Dettwiler-Danspeckgruber A, Duliba T, Bruce J, Furtado JL, & Murugavel M (2014). Prospective Clinical Assessment Using Sideline Concussion Assessment Tool-2 Testing in the Evaluation of Sport-Related Concussion in College Athletes. Clinical Journal of Sport Medicine PMID: 24915173

5 comments:

Tricia said...

This article shows a high level of clinical importance. As an athletic trainer who used to work at a high school, it is reassuring to know that the type of concussion assessment tools I used have research backing. It is particularly reassuring to know that the SCAT2 still has good specificity and sensitivity when lacking a baseline measure because sometimes it is difficult (time/resources) to obtain baseline measures at that level. While working at the high school I also found that most often, the concussed athletes would score similarly on their assessments and their baseline. It is interesting for me to learn that this was also found in research and more importantly that uninjured athletes tend to score better on a subsequent test than on their baseline.

Jane McDevitt said...

Tricia,

You pointed out something really important. There are learning curves with many of these concussion assessments. I feel the reason the concussed athletes scored similarly on this assessment compared to baseline is because there is a learning curve. Therefore, if the athlete was not concussed he/she should have scored higher. I do think baseline testing is helpful, but as this study points out it does not make this test obsolete without one.

Anonymous said...

I would like to see what research says about using one tool to remove an athlete from participation, and using another to allow them to return. For example, a sideline assessment if the athlete is injured during a game but being cleared using computerized testing. Not that they both aren't accurate measurements, but for the sake of consistency, I wonder if there are any discrepancies between the two? Also, it's good to know that SCAT-2 is a reliable test even without a baseline. In many settings, it would be quite time consuming to get a baseline SCAT-2 on every athlete!

Jane McDevitt said...

I believe it would be difficult to make 1 tool for diagnosis and 1 tool for return to play. There are so many s/s following a concussion (i.e., vesitibular and balance impairments, ocular problems, cognitive deficits), and currently there is not one tool that has all of the components that provide enough sensitivity and specificity for diagnosis let alone return to play. However, you bring up a good point. There really hasnt been a lot of testing on the reliability of these tests for the athlete to be ready for return to play. Much of the research on these tests confirms their ability to diagnose a concussion, and not how well they are for returning an athlete to play.

Chelsea Williamson said...

I agree with Tricia in the clinical importance of the SCAT2 having good specificity and sensitivity when lacking baseline measures. At the junior college level there was not enough man power to get baselines on every single student-athlete, nor a budget for computerized tests. While some scored quite well, the symptom score sheet was enough to take them out. For others, I believe while going through the SCAT2 the student-athletes were able to recognize things weren't normal for them.

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