Gender and age predict outcomes of cognitive, balance and vision testing in a multidisciplinary concussion center

https://doi.org/10.1016/j.jns.2015.04.029Get rights and content

Highlights

  • This study examined components of the SCAT3 and a test of rapid number naming.

  • Symptom severity correlated with older age, female gender, and time to evaluation.

  • Vision and balance tests showed worse scores with increasing age.

  • Scores did not differ by gender or by duration since the concussion event.

  • Our study supports novel use of sideline assessment tools in an outpatient setting.

Abstract

Objective

This study examined components of the Sports Concussion Assessment Tool, 3rd Edition (SCAT3) and a vision-based test of rapid number naming (King–Devick [K-D]) to evaluate sports and non-sports concussion patients in an outpatient, multidisciplinary concussion center. While the Symptom Evaluation, Standardized Assessment of Concussion (SAC), modified Balance Error Scoring System (BESS), and K-D are used typically for sideline assessment, their use in an outpatient clinical setting following concussion has not been widely investigated.

Methods

K-D, BESS, SAC, and SCAT3 Symptom Evaluation scores were analyzed for 206 patients who received concussion care at the Concussion Center at NYU Langone Medical Center. Patient age, gender, referral data, mechanism of injury, time between concussive event and first concussion center appointment, and the first specialty service to evaluate each patient were also analyzed.

Results

In this cohort, Symptom Evaluation scores showed a higher severity and a greater number of symptoms to be associated with older age (r = 0.31, P = 0.002), female gender (P = 0.002, t-test), and longer time between the concussion event and first appointment at the concussion center (r = 0.34, P = 0.008). Performance measures of K-D and BESS also showed associations of worse scores with increasing patient age (r = 0.32–0.54, P  0.001), but were similar among males and females and across the spectrum of duration since the concussion event. Patients with greater Symptom Severity Scores also had the greatest numbers of referrals to specialty services in the concussion center (r = 0.33, P = 0.0008). Worse Immediate Memory scores on SAC testing correlated with slower K-D times, potentially implicating the dorsolateral prefrontal cortex as a commonly involved brain structure.

Conclusion

This study demonstrates a novel use of sideline concussion assessment tools for evaluation in the outpatient setting, and implicates age and gender as predictors of outcomes for these tests.

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.

Section snippets

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

References (22)

  • Z. Marinides et al.

    e: vision testing is additive to the sideline assessment of sports-related concussion

    Neurol Clin Pract

    (2015)
  • Cited by (52)

    • No differences in tandem gait performance between male and female athletes acutely post-concussion

      2020, Journal of Science and Medicine in Sport
      Citation 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.

    • Gender-specific issues in traumatic brain injury

      2020, Brain Injury Medicine: Board Review
    View all citing articles on Scopus
    1

    The first three authors contributed equally to the study and manuscript.

    View full text