Gender and age predict outcomes of cognitive, balance and vision testing in a multidisciplinary concussion center
Introduction
Many research studies on concussion have focused on sideline testing for sports-related injuries and have investigated assessment tools such as the Sports Concussion Assessment Tool, 3rd Edition (SCAT3). Visual assessments of rapid number naming, including the King–Devick (K-D) test, have also been extensively studied. While these tools are useful on the sideline [1], [2], [3], [4], [5], [6], their administration in the outpatient clinical setting following a concussive event or mild traumatic brain injury (TBI) has not been widely investigated. Using these tools at an outpatient, urban-based, multidisciplinary concussion center, patients were examined across the age spectrum who suffered concussions by a wide variety of sports- and non-sports-related mechanisms.
Three sections of the SCAT3: the SCAT3 Symptom Evaluation, the Standardized Assessment of Concussion (SAC, a brief cognitive test), and the modified Balance Error Scoring System (BESS) were utilized in the current study. A vision-based test of rapid number naming, the K-D test, was also administered. Rapid number naming tasks require saccadic (fast to a target) and other eye movements, and may be impaired following concussion [7], [8], [9].
The purpose of this study was to examine characteristics of patients from a recently established multidisciplinary concussion center. The profile of scores from performance measures of K-D, SAC and BESS were determined in the outpatient clinical setting. Given the sports and non-sports model of care at a multidisciplinary concussion center, this study presents a unique opportunity to measure characteristics of the SCAT3 Symptom Evaluation, SAC, BESS and K-D test in a heterogeneous cohort of patients.
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Subjects and methods
Patients 6 years of age or older that had received care for a diagnosis of concussion at the Concussion Center at NYU Langone Medical Center were invited to participate in data collection for the NYU Concussion Center Registry. The Institutional Review Board (IRB) at the NYU School of Medicine approved all study protocols. Informed consent and/or age-appropriate assent were obtained from each participant.
The diagnosis of concussion was established at the time of all initial patient visits using
Patient characteristics and patterns of multidisciplinary referral
Characteristics of the study cohort are summarized in Table 1. The mean age of the cohort was 35 ± 16 years, with a range of 10–77 years. Among 206 patients with concussion, 80 sustained a concussion during sports participation; the remaining 126 developed concussion following a motor vehicle accident, fall, assault, or other type of trauma. Patients with sports-related injuries were younger (25 ± 14 years, range 10–65) than those with non-sports injuries (41 ± 14 years, range 14–77). The most common
Discussion
This study examined the profile and potential usefulness of sideline concussion assessment tools within the outpatient setting of a multidisciplinary concussion center that evaluates patients with both sports- and non-sports related injuries. The results of this study demonstrate that differences in the subjective, self-reported Symptom Severity Score and Total Symptom Score may be associated with age, gender, and length of time between the patient's concussion and their first evaluation. In
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2020, Journal of Science and Medicine in SportCitation Excerpt :Despite these recent advancements in understanding differences between female and male athletes after concussion, the literature remains mixed,8,9 and sex specific differences in postural control have received even less attention. The Balance Error Scoring System (BESS) is the most frequently used assessment for post-concussion postural control, and currently published work suggests that there are no sex differences in baseline or post-concussion BESS scores.10–12 While BESS scores typically increase (get worse) post-concussion, sex does not mediate these changes.
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The first three authors contributed equally to the study and manuscript.