Sport concussion assessment tool-second edition in an emergency department setting

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Abstract

Objective

To investigate the clinical usefulness of the Sport Concussion Assessment Tool-Second Edition (SCAT2) in patients with mild traumatic brain injuries (MTBI).

Design

A cross-sectional, descriptive study.

Setting

Emergency Department of Tampere University Hospital, Finland.

Patients

Patients (N=38, 26 men and 12 women) between the ages of 18 and 60 years, with no premorbid medical or psychiatric conditions, who met the WHO criteria for MTBI were enrolled. Alcohol intoxication was an exclusion criterion.

Interventions

A broad clinical assessment and the SCAT2 were completed within 4 days postinjury (Median=19.6 h, SD=24.8, Range=2–94.5 h). CT of the head was performed in the ED. A head MRI was done within 1 week postinjury.

Main Outcome Measurements

Outcome measurements included clinical injury severity markers (loss of consciousness (LOC), GCS, post-traumatic amnesia (PTA), retrograde amnesia (RA), disorientation, and focal neurological deficits), and the SCAT2 subscores and total score.

Results

The mean SCAT2 total score was 76.4 (SD=9.7, range=52–93). The mean Standardised Assessment of Concussion score was 25.3 (SD=2.1, range=21–30), balance score was 20.9 (SD=6.7, range=8–30), and symptom severity score was 16.6 (SD=14.1, range=0–60). The vast majority of the sample endorsed 5 or more symptoms (89.5%). The SCAT2 total scores and subscores were not significantly associated with the MTBI severity markers (eg, LOC, PTA, and RA) or imaging findings.

Conclusions

The SCAT2 measures the acute consequences of MTBI reasonably well in many civilian patients with MTBIs. However, the scores do not reflect the clinical or radiological severity of injury.

Acknowledgements

The authors would like to thank research assistants Anne Simi for her contribution in data collection.

Competing interests

Grant Iverson has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. These include, but are not limited to, the National Academy of Neuropsychology, American Academy of Clinical Neuropsychology, International Neuropsychological Society, US Department of Defense, and Australasian Faculties of Rehabilitation Medicine and Occupational and Environmental Medicine, and the Swiss Accident Insurance Fund. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received honorariums for serving on research panels that provide scientific peer review of programs (eg, the Military Operational Medicine Research Program). He is a co-investigator, collaborator, or consultant on grants funded by several organizations, including, but not limited to, the Canadian Institute of Health Research, Alcohol Beverage Medical Research Council, Rehabilitation Research and Development (RR&D) Service of the US Department of Veterans Affairs, AstraZeneca Canada, Lundbeck Canada, and Pfizer Canada. He works part-time as a contractor, doing TBI in the military research, for the Defense and Veterans Brain Injury Center.

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