Access to athletic trainers and sex as modifiers of time to reach clinical milestones after sport-related concussion in collegiate athletes.

OBJECTIVE: Investigate whether an athlete's biological sex and exposure to a dedicated athletic trainer (AT) were related to clinical milestones after a sports-related concussion (SRC). DESIGN: Retrospective chart review. METHODS: Medical charts of collegiate athletes (n = 196 [70.9% female]) diagnosed with SRC were reviewed to extract: biological sex, dedicated AT exposure for their sport (yes/no), and time (days) to reaching clinical milestones (diagnosis, symptom resolution, unrestricted return to sport [RTS]). Mann-Whitney U tests were used to determine whether time to clinical milestones differed by sex, AT exposure, or their interaction. Proportions of same-day diagnoses and times to diagnosis, symptom resolution, and unrestricted RTS were evaluated with chi-squared and spearman's rank correlations, respectively. RESULTS: There were no significant differences in times to reaching any clinical milestone by sex, AT exposure, or their interaction (ps > 0.05). Forty-three percent of participants were diagnosed on the day of their SRC. This did not differ by sex or AT exposure (ps > 0.29). Longer times to SRC diagnosis were associated with more days to symptom resolution (ρ = 0.236, p = 0.001) and unrestricted RTS (ρ = 0.223, p < 0.001). CONCLUSIONS: Athlete sex and AT exposure were not associated with times to reach any clinical milestone; however, delayed diagnosis was associated with longer times to reach clinical recovery.

Language Matters: Comparisons of Concussion Assessments Among English and Spanish Speaking Middle School Athletes.

CONTEXT: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) is among the most widely used international pediatric concussion evaluation tools. The tool's English-only development may limit its use for patients who speak different languages. Prior research suggests preferred language (i.e., home language) could be associated with concussion assessments in adults, however this is not well understood among pediatric athletes. OBJECTIVE: To compare baseline Child SCAT5 assessment outcomes between middle school athletes whose home language is Spanish and matched controls whose home language is English. DESIGN: Case-Control. SETTING: Middle School Athletics. PATIENTS OR OTHER PARTICIPANTS: Athletes self-reported their home language (i.e., "language spoken at home"). Athletes indicating their home language was Spanish were individually matched to athletes that spoke English at home on age, gender, sport, school, and pertinent comorbidities (e.g., concussion history). The final sample included 144 athletes (Spanish home language: n=72, English home language: n=72). DATA COLLECTION AND ANALYSIS: Mann Whitney U tests compared the home language groups (i.e., 19 Spanish vs English) on the Child SCAT5 component scores. RESULTS: Athletes in the Spanish home language group scored lower on the Standardized Assessment of Concussion - Child version (p<.01, r=-.25), Immediate Memory (p<.01, r=-0.45), and Total Modified Balance Error Scoring System scores (p<.01, r=-0.25) compared to the English home language group. CONCLUSIONS: Matched athletes whose home language was Spanish versus English scored differently on baseline Child SCAT5 assessment components. Those with the home language of Spanish scored lower on cognitive and balance tasks compared to those whose home language was English. These findings may serve as rationale for future concussion assessment tools to properly capture clinically relevant data representative language differences among pediatric athletes.

The Clinical Utility of the Child SCAT5 for Acute Concussion Assessment.

BACKGROUND: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5 and 12 years of age for a suspected concussion. However, limited empirical evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion. METHODS: Our participants included 34 concussed (21 boys, 13 girls; age = 12.8 ± 0.86 years) and 44 non-concussed (31 boys, 13 girls; age = 12.4 ± 0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes ([Formula: see text]) were calculated to assess the magnitude of difference for each comparison. The diagnostic properties (sensitivity, specificity, diagnostic accuracy, predictive values, likelihood ratios, and diagnostic odds ratio) of each Child SCAT5 score were also calculated. RESULTS: Concussed children endorsed more symptoms (p < 0.001, [Formula: see text]=0.45), higher symptom severity (p < 0.001, [Formula: see text]=0.44), and had higher double leg (p = 0.046, [Formula: see text]=0.23), single leg (p = 0.035, [Formula: see text]=0.24), and total scores (p = 0.022, [Formula: see text]=0.26) for the mBESS than the non-concussed children. No significant differences were observed for the SAC-C scores (p's ≥ 0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC = 0.76-0.77), negative predictive values (NPV = 0.84-0.88), and negative likelihood ratios (-LR = 0.22-0.31) of the Child SCAT5 scores. CONCLUSIONS: Clinicians should prioritize interpretation of the symptom evaluation form of the Child SCAT5 as it was the most effective component for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.

Interpreting change on the Child Sport Concussion Assessment Tool 5th Edition.

OBJECTIVES: The purpose of this study was to examine the one-year test-retest reliability of Child Sport Concussion Assessment Tool 5th Edition component scores and provide recommendations for interpreting change on its component tests. DESIGN: A prospective cohort study was conducted across two years via the Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project. METHODS: Participants were 219 children (ages 11 to 12, M = 11.7, SD = 0.5; 52.1% girls, 47.9% boys) playing competitive school-sponsored sports in nine middle schools across a large public-school division in Virginia, USA during the 2017-2018 and 2018-2019 academic years. Athletic Trainers administered the baseline Child Sport Concussion Assessment Tool 5th Edition each year. RESULTS: Test-retest reliability estimates for each Child Sport Concussion Assessment Tool 5th Edition component were low to moderate (ICCs=0.40-0.55). A minority of middle school athletes (15-31%) scored within a different normative classification range upon re-assessment. The following test-retest difference scores occurred in 20% or fewer of the sample: +5 total symptoms, +7 symptom severity, -2 in the Standardized Assessment of Concussion - Child Version total score, and +4 total Modified Balance Error Scoring System balance errors. CONCLUSIONS: Child Sport Concussion Assessment Tool 5th Edition component scores had poor to moderate test-retest reliability coefficients over a one-year period, though most children were classified as falling within the same interpretive category upon re-testing based on local norms. We report the raw score changes that were uncommon in our sample of uninjured children to help clinicians identify changes that might be clinically meaningful.

Child Sport Concussion Assessment Tool 5th Edition: Normative Reference Values in Demographically Diverse Youth.

OBJECTIVES: Examine sociodemographic differences (gender, age, and language spoken at home) on baseline Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) scores and establish normative reference data for the Child SCAT5 among middle school student athletes. DESIGN: Cross-sectional study. SETTING: Nine middle schools in Virginia. PARTICIPANTS: A sample of 1355 athletes playing competitive school-sponsored sports (ages 11-13, M = 12.3 ± 0.8; 40.1% girls, 59.9% boys) during the 2017 and 2018 school year. Certified athletic trainers administered the Child SCAT5 within the first 2 weeks of the sport season. INDEPENDENT VARIABLES: Self-reported gender, age, and language spoken at home. MAIN OUTCOME MEASURES: All Child SCAT5 outcome measures. RESULTS: Gender, age, and language spoken at home were associated with Child SCAT5 scores, but the magnitude of differences was generally small. Specifically, girls endorsed more symptoms (girls: M = 8.4 ± 5.7, boys: M = 7.5 ± 5.7; P = 0.003) and greater symptom severity (girls: M = 11.6 ± 9.4, boys: M = 10.4 ± 9.3; P = 0.006) than boys and performed slightly better than boys on cognitive and balance tasks. Older students performed slightly better than younger students on tests of cognition (eg, SAC-C: 11-year-olds: M = 21.3 ± 2.1, 13-year-olds: M = 21.7 ± 2.1; P = 0.02). Total symptoms (P = 0.01), symptom severity (P = 0.01), immediate memory (P < 0.001), delayed recall (P = 0.001), and SAC-C total scores (P = 0.002) differed across language groups. CONCLUSIONS: Gender, age, and language spoken in the home are associated with baseline scores on multiple components of the Child SCAT5 among middle school students, although the magnitudes of observed differences are small. Normative reference values are provided for clinicians when interpreting Child SCAT5 scores.

Children with Attention-Deficit/Hyperactivity Disorder Perform Differently on Pediatric Concussion Assessment.

OBJECTIVE: To compare Child Sport Concussion Assessment Tool Fifth Edition (Child SCAT5) performance between uninjured children with attention-deficit/hyperactivity disorder (ADHD) and precisely matched controls without ADHD. STUDY DESIGN: A nested case-control study was conducted within a cohort of middle school athletes (age 11-12 years) who completed preseason testing. Students with ADHD were individually matched to students without ADHD based on age, sex, language spoken at home, number of prior concussions, sport, and school they attended. The final sample included 54 students (27 with ADHD and 27 controls), 38 (70.4%) boys and 16 (29.6%) girls (average age: 11.7 years, SD = 0.5). RESULTS: Children with ADHD reported more symptoms (M = 13.33, SD = 5.69, P < .001) and greater symptom severity (M = 22.59, SD = 1 1.60, P < .001) compared with controls (total symptoms: M = 6.44, SD = 4.96; symptom severity: M = 8.04, SD = 6.36). Children with ADHD performed similarly to controls on the Child SCAT5 cognitive tests. Children with ADHD committed 3 times as many total balance errors (median = 6) than children without ADHD (median = 2) and committed twice as many errors on single leg stance (ADHD median = 4; No ADHD median = 2) (P values < .001). CONCLUSIONS: Children with ADHD endorsed more concussion-like symptoms and performed worse on balance testing during preseason Child SCAT5 assessment compared with matched controls without ADHD. These findings highlight the challenges of interpreting Child SCAT5 performance in children with ADHD following a concussion or suspected concussion and illustrate the value of administering the measure to children to document their pre-injury performance.