Refining the Clinical Usefulness of the Child Sport Concussion Assessment Tool 5th Edition
Date
2020
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Abstract
Our goal, through this program of research, was to improve the evaluation of sports-related concussion in children. To do so, three research studies were conducted using the Child Sport Concussion Assessment Tool, 5th Edition (Child SCAT5) among a diverse cohort of children ages 11 to 13 years participating in public school sponsored sports programs. As such, we aimed to (i) create evidence-based guidance to determine what constitutes typical or “normal” Child SCAT5 performance among healthy, uninjured children; (ii) understand the temporal stability and reliable change of the Child SCAT5 in a healthy, uninjured sample; and (iii) describe the sideline performance of children on the Child SCAT5 who were diagnosed with a concussion. We observed the following: (i) Gender, age, and language spoken at home are associated with baseline performance on multiple components of the Child SCAT5 among middle school students, though the magnitudes of observed differences are small. Normative reference values are provided for clinicians when interpreting Child SCAT5 scores. (ii) The Child SCAT5 scores had low test-retest reliability over a one-year period. Despite this, we provide the distributions of Child SCAT5 raw score changes upon retesting to aid clinicians in interpreting changes that are uncommon in an uninjured sample. (iii) The Child SCAT5 was useful for measuring the ultra acute effects of concussion in children. Certain symptoms on the symptom scale were more clinically useful for sideline assessment than others. Interpretation methods relying on comparisons of post-injury test scores to baseline preseason scores and normative reference values were both useful for detecting impairment within the concussed middle school sample. However, both had limitations that are important for clinicians to be aware of. In summary, the assessment of concussion in children is complex and requires the careful consideration of multi-dimensional and sometimes contradictory information. As such, the Child SCAT5 should be viewed as tool to gather data that informs clinical judgment and should not be used in isolation to diagnose a concussion. Future research should replicate and extend these findings to include greater time intervals following injury, and larger samples of children, to further refine the assessment of concussion in children.