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.
Summary Points:
- Examined the utility of SCAT3 symptoms evaluation, SAC, mBESS, and K-D Tests as clinical tools to evaluate concussion patients ages 10-77 in an outpatient concussion center.
- Worse K-D Test and mBESS scores were associated with increasing age.
- Worse Immediate Memory scores on SAC testing correlated with slower K-D times.
- Worse K-D scores were associated with higher symptom severity scores.
- The dorsolateral prefrontal cortex involves working memory, saccadic function, motor planning, and emotional control, which may, in part, explain the correlation between tests.