Validation of a Concussion Assessment Tool

Abstract

Objective Sports related concussions, ormild traumatic brain injuries, have been steadily increasing over the past two decades. Effective screening and identification of concussions play a critical role in the diagnosis and rehabilitation process. Although side line assessment tools are available, there are few well validated tests available to assist medical providers in this decision-making process. This study aims to determine whether previously validated tools which assess neurocognitive and neurophysiological abilities can predict concussion symptom endorsement in a sample of child and adolescent athletes. Background Participants were recruited from two settings: The office of a pediatric neurologist (seen 3 to 109 days post incident) and from preseason baseline assessments. Design/Methods Method: Participants were 113 individuals, aged 6 to 17, representing 84 consecutive cases of individuals completing standardized baseline assessments with no recent history of concussion, and 29 consecutive cases undergoing a post-concussion evaluation by a pediatric neurologist. Participants completed a standardized battery of tests comprised of the Connors' Continuous Performance Test (CPT-3), the Balance Error Scoring System (BESS) and the NIH 4-meter Gait Test and completed a checklist of CDC concussion symptoms. Results The screening battery explained 33% of the variance (d = 1.4) in concussion symptom endorsement, after controlling for age. The neurocognitive test alone (CPT-3) accounts for 21.5% of the variance (d = 1.05) in symptoms after controlling for age, and the neurobehavioral measures (BESS and NIH 4m Gait) then account for an additional 11.5% variance (they account for 18.6% variance, d = 0.96, when entered first). These effect sizes are considered large to very large and reflect a marked increase in predictive validity relative to existing measures used in concussion assessments. Conclusions An easy to administer and relatively brief screening test can be used in medical settings to identify concussions and predict significant and substantial variability in CDC concussion symptoms.