Evaluation of the Standardized Assessment of Concussion in a Pediatric Emergency Department
ABSTRACT The Standardized Assessment of Concussion (SAC) is a validated tool for identifying the effects of mild traumatic brain injury (mTBI). Previous research focused on sport-related sideline evaluation of adolescents and adults. Our goal was to evaluate performance of the SAC among subjects with and without head injury in a pediatric emergency department (ED).
This was an observational study of children 6 to 18 years of age who presented to an ED with blunt head injury (case-patients) or minor extremity injury (controls). SAC and graded-symptom-checklist scores were compared. American Academy of Neurology concussion grades, presence of loss of consciousness and posttraumatic amnesia were also compared with SAC and graded-symptom-checklist scores among case-patients.
Three hundred forty-eight children were enrolled. SAC scores trended lower (greater cognitive deficits) for case-patients compared with controls but did not reach significance. Graded-symptom-checklist scores were significantly higher among case-patients. Presence of altered mental status magnified this effect. There was no correlation between SAC scores and other indicators of mTBI. There was a positive correlation between graded-symptom-checklist scores and posttraumatic amnesia and American Academy of Neurology concussion grade.
The graded symptom checklist reliably identified mTBI symptoms for all children aged 6 years and older. SAC scores tended to be lower for case-patients compared with controls but did not reach significance. Patients with altered mental status at the time of injury manifest an increased number and severity of symptoms. Additional research into strategies to identify cognitive deficits related to mTBI and classify mTBI severity in children is needed.
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- "We used a version of Graded Symptoms Checklist or GSC. The GSC is commonly used for early assessment of head trauma in children and adolescents (e.g., Grubenhoff et al. 2010) and in college football players (McCrea et al. 2005). "
ABSTRACT: Athletic head trauma (both concussive and sub-concussive) is common among adolescents. Head trauma often is followed by motion sickness-like symptoms, by changes in cognitive performance, and by changes in standing body sway. We evaluated adolescent female boxers who did and did not report motion sickness after a bout (i.e., a boxing match), together with a control group of non-boxers. We asked whether pre-bout body sway would differ between boxers who experienced post-bout motion sickness and those who did not. In addition, we asked whether pre-bout cognitive performance would differ between non-boxers and boxers with and without post-bout motion sickness. Seven of twenty boxers reported motion sickness after a bout. Pre-bout measures of cognitive performance and body sway were different in boxers who reported post-bout motion sickness than in boxers without post-bout sickness or controls. The results suggest that susceptibility to motion sickness-like symptoms in adolescent female boxers may be manifested in characteristic patterns of body sway and cognitive performance. It may be possible to use pre-bout data to predict susceptibility to post-bout symptoms.Experimental Brain Research 03/2014; 232(8). DOI:10.1007/s00221-014-3910-4 · 2.17 Impact Factor
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ABSTRACT: Concussion, defined as an impulse blow to the head or body resulting in transient neurologic signs or symptoms, has received increasing attention in sports at all levels. The King-Devick (K-D) test is based on the time to perform rapid number naming and captures eye movements and other correlates of suboptimal brain function. In a study of boxers and mixed martial arts (MMA) fighters, the K-D test was shown to have high degrees of test-retest and inter-rater reliability and to be an accurate method for rapidly identifying boxers and mixed martial arts fighters with concussion. We performed a study of the K-D test as a rapid sideline screening tool in collegiate athletes to determine the effect of concussion on K-D scores compared to a pre-season baseline. In this longitudinal study, athletes from the University of Pennsylvania varsity football, sprint football, and women's and men's soccer and basketball teams underwent baseline K-D testing prior to the start of the 2010-11 playing season. Post-season testing was also performed. For athletes who had concussions during the season, K-D testing was administered immediately on the sidelines and changes in score from baseline were determined. Among 219 athletes tested at baseline, post-season K-D scores were lower (better) than the best pre-season scores (35.1 vs. 37.9s, P=0.03, Wilcoxon signed-rank test), reflecting mild learning effects in the absence of concussion. For the 10 athletes who had concussions, K-D testing on the sidelines showed significant worsening from baseline (46.9 vs. 37.0s, P=0.009), with all except one athlete demonstrating worsening from baseline (median 5.9s). This study of collegiate athletes provides initial evidence in support of the K-D test as a strong candidate rapid sideline visual screening tool for concussion. Data show worsening of scores following concussion, and ongoing follow-up in this study with additional concussion events and different athlete populations will further examine the effectiveness of the K-D test.Journal of the neurological sciences 08/2011; 309(1-2):34-9. DOI:10.1016/j.jns.2011.07.039 · 2.26 Impact Factor
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ABSTRACT: To examine the frequency of acute mild traumatic brain injury (mTBI) symptoms in children using a concussion symptom inventory and to identify which symptoms are most useful in identifying mTBI. It was hypothesized that symptoms associated with mTBI are more common in children with head injury than orthopaedic injury and certain symptoms are more useful than others in identifying mTBI. Research design: Prospective case-control study conducted in a paediatric trauma centre emergency department. Children of 6-18 years old with head injury or a minor extremity injury were enrolled. Symptoms were assessed using a graded symptom checklist. Symptom frequency was compared using a chi-square test. The association between individual symptoms with AMS was evaluated with logistic regression analysis. Children with head injury displayed more frequent symptoms than controls. Head-injured cases with altered mental status (AMS) demonstrated the most frequent and severe symptoms (median symptom scores: control = 1, cases without AMS = 5, cases with AMS = 10; p < 0.001). Headache, nausea, dizziness, blurred/double vision and not feeling 'sharp' were associated with AMS. Symptoms associated with mTBI are more frequent in children with head injury. AMS magnifies this effect. A symptom inventory is integral to the evaluation of mTBI in children; a smaller set of dichotomized symptoms may be as useful as and more easily administered than lengthier symptom scales.Brain Injury 09/2011; 25(10):943-9. DOI:10.3109/02699052.2011.597043 · 1.86 Impact Factor