and Team Differences on Baseline Measures of Sport-Related Concussion

Zimmer A, Piecora K,
Schuster D, Webbe F. Journal of Athletic Training. 2013;48(5):659-667.

Home Message: Sport and height may affect performance on baseline concussion
assessments. Therefore, when athletic trainers evaluate a patient who lacks a
baseline concussion assessment they should be cautious using normative data
because it may not be optimal.

Pre-season baseline
concussion testing of athletes is not always possible. When baseline
measurements are unavailable it is recommended that athletic trainers compare
testing performance to normative results. However, it is unknown if there are
factors that affect normative results for performance on baseline concussion
assessments. Therefore, the purpose of this study was to determine if various
sports and teams perform differently on baseline concussion testing and to
determine if athlete characteristics – such as, sex and height – play a role. 437 student-athletes who competed across 10 varsity sports and 18 athletic
teams of a NCAA Division II university performed baseline concussion testing.
The student-athletes completed the Concussion Resolution Index (CRI), Balance Error Scoring System (BESS), and the Standardized Assessment of Concussion (SAC). The authors
found no consistent differences between sexes across all three baseline
concussion tests. Also, they found no differences in SAC scores among the
athletic teams. In contrast, teams differed in BESS testing and CRI
performance. Women’s soccer performed the best in BESS testing on a hard
surface while men’s basketball performed the worst. For the CRI, baseball and
soccer players, regardless of sex, had faster processing speeds than male
basketball athletes. Furthermore, men’s cross-country athletes had slower
reaction times compared with softball and women’s rowing. They also found that
height was a key factor in BESS performance. Taller individuals performed worse
on BESS testing than shorter individuals.

This study suggests that
sports/teams may perform differently on baseline concussion assessments and
that individual factors, like height, may influence balance scores. Therefore,
using normative comparisons in concussion evaluations may not be optimal. This
ultimately suggests that baseline comparisons should be utilized over normative
comparisons if possible. If a baseline comparison is unavailable to a
clinician, then the clinician should consider the differences that may exist
between sports (such as reaction time and BESS performance on a hard surface) to
make the safest return-to-play decisions. When it is necessary to rely on
normative data it would be beneficial if we could compare our patient’s test
results to age, sex, and sport-specific normative values. Fortunately, although
differences were noted at baseline between teams, it is unclear if these
differences are enough to change the overall results of a concussion
evaluation. Overall, clinicians should use a variety of different measures in posttraumatic
concussion evaluations, including the SAC, to minimize the influence of sport
and other individual characteristics (e.g., height) on test outcomes.

for Discussion: Have you ever conducted concussion testing on an athlete
without baseline scores? What normative values did you use to compare?

Written by: Tiffany
Reviewed by: Lisa Chinn
and Jeffrey Driban

Related Posts:

Zimmer A, Piecora K, Schuster D, & Webbe F (2013). Sport and team differences on baseline measures of sport-related concussion. Journal of Athletic Training, 48 (5), 659-67 PMID: 23952044