Sideline concussion tests may be useful in the emergency department

doctor giving exam

Traumatic brain injury (TBI) is a serious and widespread public health issue, accounting for millions of hospitalizations and deaths each year and costing the United States up to $82 billion each year. Individuals who present to emergency departments with TBI typically undergo brain imaging procedures to determine the extent of their injuries. However, in cases of mild TBI (or concussion), brain imaging may fail to show damage, so clinicians are motivated to find alternate assessment methods that can quickly and accurately diagnose TBI in patients with concussion.

One of these methods is a sideline concussion measure called the Sport Concussion Assessment Tool Version 3 (SCAT3), which is commonly used to identify and monitor concussions in athletes. Critical components of the SCAT3 include Concussion Symptom Severity Score (CSSS) and modified Balance Error Scoring System (mBESS). Although these measures were designed for implementation in a sports context, they may also be valuable for clinical assessments of concussion in emergency departments.

A group of researchers in Iowa explored the effectiveness of the CSSS and the mBESS sideline concussion tools as a clinical method for identifying TBI. To validate these tools, the researchers administered the CSSS to 147 patients with TBI. Only 51 participants were able to complete the mBESS. To determine if the sideline concussion tools could accurately predict TBI severity, the researchers then compared participants’ scores on the CSSS and mBESS to other clinical data, such as brain imaging scans, length of hospital stay, and frequency of headaches. They found that the CSSS accurately identified TBI in the emergency department, while the mBESS did not. Most of the participants couldn’t complete the mBESS, which tests a person’s balance. Although useful in a sports context, the mBESS doesn’t appear suitable for the emergency department.

Due to the prevalence of brain injuries among athletes, sports-related research is valuable for the advancement of TBI diagnostics and treatments. Sideline concussion tools can provide clinicians with alternate methods of assessing TBI, especially in mild cases where typical brain imaging does not reveal structural damage. However, some sports concussion tools are better suited for emergency departments than others, and further research is necessary to determine best methods for adaptation to clinical contexts.

Kruse AJ, Nugent AS, & Peterson AR. Using sideline concussion tests in the emergency department. Open access Emergency Medicine. (September 2018).

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