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Concussion baseline needed for accurate future assessment of adolescent athletes
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 Anikar Chhabra |
SAN DIEGO – Clinicians should administer baseline assessments of the Sport Concussion Assessment Tool 2. However, relying on a perfect baseline score is not appropriate in adolescent athletes, according to a presenter here.
“SCAT2 should not be solely used to determine return to play,” Anikar Chhabra, MD, MS, said at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.
Chhabra and his team found that otherwise healthy adolescent athletes display variability in results, so establishing each player’s own baseline before the season starts and then comparing it to test results following a concussion leads to more accurate diagnosis and treatment.
The investigators administered the new Sport Concussion Assessment Tool 2 (SCAT2) to 872 male and 262 female adolescent athletes with an average age of 15 years who participated on an interscholastic athletic team. The SCAT2 is comprised of a 22-item graded symptom scale, two-item sign score, Glasgow Coma Scale (GCS), Maddocks questions, Standardized Assessment of Concussion (SAC), modified Balance Error Scoring System (BESS) and coordination examination. The SCAT2 total score has a maximum of 100 points and is calculated by summing each component score. Two independent t-tests, with gender and concussion history as independent variables, were conducted to assess differences in the SCAT2 total score. The dependent variable was the SCAT2 total score. Lower scores on the SCAT2 indicate greater deficits.
The SCAT2 total score across all athletes was 88.3. Athletes with a prior history of at least one concussion scored significantly lower on the SCAT2 total score compared with those who did not have a history of concussion. Male athletes scored lower than female athletes and non-concussed peers.
Variability in baseline SCAT2 scores was due to the symptom score, SAC and BESS, Chhabra said. These values suggest that otherwise healthy adolescent athletes display variability at baseline. Therefore, it is recommended that the SCAT2 test should not be used to determine return to play status without individualized baseline SCAT2 values.
“The evaluation of an athlete suspected of mild traumatic brain injury (MTBI) should include a complete mini-mental state exam and complete neurologic physical examination because the diagnosis of MTBI is a diagnosis of exclusion of other neurologic and neurosurgical diagnosis,” Chhabra said.
Reference:
- Chhabra A, Bay RC, Lam TC, Valovich McLeod TC. Sideline management of concussions in adolescent athletes: Can the Sport Concussion Assessment Tool 2 (SCAT2) be accurately used to determine return to play status? Paper #15. Presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 7-10. San Diego.
- Disclosure: Funding provided by a grant from the National Operating Committee on Standards for Athletic Equipment.
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