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Composite of tools best for diagnosing sideline concussions, speaker says
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PHILADELPHIA – In a panel presentation at Optometry’s Meeting discussing current concepts in diagnosis and management of sports-related concussions, Steven Galetta, MD, focused on various tests to diagnose the concussions, especially on the sidelines.
Galetta, the Philip K. Moskowitz, MD, professor and chair of neurology at the NYU Langone Medical Center, was joined by David Kirschen, OD, PhD, who moderated the panel, as well as Matthew Kirschen, MD, PhD; Mitchell Scheiman, OD; and Matthew Grady, OD.
In defining concussions, Galetta noted: “Concussion is the most common form of mild traumatic brain injury (mTBI) – but there is nothing mild about a traumatic brain injury.
“There are nearly 4 million concussions in sports,” he continued.
Galetta discussed a study in which he demonstrated the need for a rapid sideline test to diagnose concussions.
The study consisted of a survey of University of Pennsylvania athletes who were asked about their concussions, according to Galetta. He said that the anonymous survey was taken by 256 students; results showed that 43% had hidden a concussion, and 22% said they would do so again in the future.
“They didn’t want to let their teammates down, they didn’t want to come out of the game or they just didn’t know it was a concussion,” Galetta said, “further emphasizing why we need tools on the sideline to help us diagnose concussion.”
Galetta also specifically addressed why eye movement tests are critical in diagnosing concussions.
“Not every deficit that occurs after concussion is cognitive,” he said in his presentation. “Impaired eye movements are an established indicator of suboptimal brain function and may capture dysfunction not observed in cognitive testing.”
He noted a 2012 Military Medicine study that evaluated visual dysfunction in patients that had experienced a blast-induced mTBI.
“Even 15 to 45 days after concussion, saccades are abnormal in 30%, pursuit, convergence and accommodation are all up there, about 60% of the time,” he said.
Specific to athletes, Galetta said that the most effective and accurate means of diagnosing concussions on the sidelines is by combining multiple tests.
He cited a study from the University of Florida currently in press that demonstrated the need for a combination of tools to diagnose concussions.
The study, to be published in Neurology: Clinical Practice, used the Standardized Assessment of Concussion (SAC) test, the Balance Error Scoring System (BESS) or King-Devick (KD) test to evaluate 217 athletes. According to data shared by Galetta, the SAC test diagnosed 50% of concussions, the BESS test diagnosed 80% of concussions, and the KD test diagnosed 79% of concussions. Together, the diagnostic tools were capable of diagnosing 100% of the concussions.
“No single tool was diagnostic of every concussion,” Galetta said. “But when we used a cognitive tool and the SAC and the BESS and the KD, that did identify 100% of the concussed athletes.”
“A composite test and sequential testing is likely to be the paradigm of the future,” Galetta concluded. – by Chelsea Frajerman