Is the Sport Concussion Assessment Tool 5th Edition a useful concussion assessment tool in head-injured patients presenting to the emergency department?

OBJECTIVE: Concussion is a common ED complaint, but diagnosis is challenging as there are no validated objective measures. Use of concussion tools derived from sports medicine is common, but these tools are not well validated in ED settings. The aim of this study was to assess the ability of the Sport Concussion Assessment Tool 5th Edition (SCAT5) to identify concussion in ED patients presenting following head injury. METHODS: We conducted a prospective observational study of head-injured adult patients presenting to ED between March and July 2021. ED diagnosis of concussion was used as the diagnostic standard, and we assessed the diagnostic performance of the SCAT5 test and its three subsections (Standardised Assessment of Concussion (SAC), Post-Concussion Symptom Scale (PCSS) and Modified Balance Error Scoring System (mBESS)) against this. RESULTS: Thirty-two head-injured participants were enrolled, 19 of whom had a discharge diagnosis of concussion, alongside 17 controls. Median time for SCAT5 testing was 21 (interquartile range 16-27) min. Fifteen (30.6%) participants were interrupted during testing. Area under the curve (AUC) (95% confidence interval) for the SAC, PCSS and mBESS were 0.51 (0.34-0.68), 0.92 (0.84-0.99) and 0.66 (0.47-0.85), respectively. Sensitivity and specificity of sections were as follows: entire SCAT5 (100.0%, 20.0%), SAC (48.1%, 60.0%), PCSS (89.7%, 85.0%) and mBESS (83.3%, 58.8%). Using PCSS alone would have identified 17 of 19 concussions. CONCLUSION: The SCAT5 test had a low specificity, was long and was frequently interrupted. We suggest it is not an ideal assessment to use in ED. The PCSS score performed well and was easy to complete. It may be useful as a standalone tool to simplify ED concussion identification.

Autologous blood injection to treat achilles tendinopathy? A randomized controlled trial.

CONTEXT: Achilles tendinopathy is a common and often debilitating condition, and autologous blood injection is a promising treatment option. OBJECTIVE: To determine whether autologous blood injection added to standard management was effective in alleviating symptoms of Achilles tendinopathy. DESIGN: A prospective randomized controlled trial. SETTING: Private sports medicine clinic. PATIENTS: 33 patients (18 women, 15 men) of mean age 50 y (SD 9) with 40 cases of Achilles tendinopathy of mean duration of 11 mo (SD 7). INTERVENTION: Participants were randomized to blind peritendinous autologous blood injection added to standard treatment (eccentric-loading exercises) or standard treatment alone for 12 wk. MAIN OUTCOME MEASURE: Victorian Institute of Sport Assessment for Achilles (VISA-A) score and ratings of discomfort during and after the injection were measured at baseline and 6 and 12 wk. Analytically derived effect-size thresholds of 5 (small) and 15 (moderate) VISA-A units were used as the reference values for clinical inference. RESULTS: Improvements in VISA-A of 7.7 units (95%CL: ± 6.7) and 8.7 units (± 8.8) were observed in the treatment and control groups, respectively, at 6 wk relative to baseline, with no clear effect of blood injection. At 12 wk VISA-A score improved to 18.9 units (± 7.4) in the treatment group, revealing a blood-injection effect of 9.6 units (± 11.5), relative to a comparatively unchanged condition in control (9.4 units; ± 9.0). Predictors of response to treatment were unremarkable, and a 21% rate of postinjection flare was the only noteworthy side effect. CONCLUSIONS: There is some evidence for small short-term symptomatic improvements with the addition of autologous blood injection to standard treatment for Achilles tendinopathy, although double-blinded studies with longer follow-up and larger sample size are required.

Knowledge and attitudes towards cardiopulmonary resuscitation in the community.

AIMS: This study examined basic aspects of knowledge and attitudes towards resuscitation in a New Zealand urban community. METHODS: Using a telephone survey, we questioned 400 subjects aged (over 17 years of age), on their prior training, knowledge, and attitudes towards resuscitation. RESULTS: Seventy-four percent of subjects had previously been taught cardiopulmonary resuscitation (CPR). Of these, 12% had been taught during the previous year, and 63% over 5 years previously. Older subjects were less likely to have learnt CPR than younger subjects. Seventy-three percent of those surveyed desired to know more about resuscitation (than they currently did) and 70% thought that resuscitation should be a compulsory component of the New Zealand Driver's Licence test. Sixty-three percent said they would be willing to perform mouth-to-mouth ventilation on a stranger. CPR knowledge was poor, however, with only 4% knowing an acceptable rate at which to perform chest compressions, and only 9% knowing the correct compression-to-ventilations ratio for adult CPR. Overall knowledge was highest for those taught in the previous year, and for those persons aged between 26 and 45 years. CONCLUSIONS: Although attitudes of the community toward CPR are positive, theoretical knowledge relating to basic CPR is poor. This suggests that present community CPR educational strategies have limited efficacy.