Show pageBacklinksExport to PDFBack to top This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong. ====== Concussion diagnosis ====== The objective diagnosis of [[concussion]] remains challenging. Although some concussion symptoms may be apparent even to nonmedical observers, diagnosis and removal from play for evaluation depend on validated assessment tools and trained vigilant healthcare personnel. Over the past 2 decades, sideline concussion measures have undergone significant revision and augmentation to become more comprehensive batteries to detect a wide spectrum of symptomatology, eg, neurocognitive function, postconcussive symptoms, gait/balance, and saccadic eye movements. A review summarizes the current state-of-the-art concussion evaluation instruments, ranging from the Sports Concussion Assessment Tool ([[SCAT]]) and tools that may enhance concussion detection, to near-term blood-based biomarkers and emerging technology (eg, head impact sensors, vestibular-ocular/eye-tracking, and mobile applications). Special focus is directed at feasibility, utility, generalizability, and challenges to implementation of each measure on-field and on the sidelines. A review of Yue et al. finds that few instruments beyond the SCAT provide guidance for removal from play, and establishing thresholds for concussion detection and removal from play in qualification/validation of future instruments is of high importance. The integration of emerging sideline concussion evaluation tools should be supported by resources and education to athletes, caregivers, athletic staff, and medical professionals for standardized administration as well as triage, referral, and prevention strategies. It should be noted that concussion evaluation instruments are used to assist the clinician in sideline diagnosis, and no single test can diagnose concussion as a standalone investigation ((Yue JK, Phelps RRL, Chandra A, Winkler EA, Manley GT, Berger MS. Sideline Concussion Assessment: The Current State of the Art. Neurosurgery. 2020 Mar 3. pii: nyaa023. doi: 10.1093/neuros/nyaa022. [Epub ahead of print] PubMed PMID: 32126135. )). ---- Findings suggestive of concussion: {{::diagnosis_of_concussion.png?600|}} The diagnosis of concussion should be considered when any of these findings occur following trauma. In pre-verbal children, findings may include: Listlessness and easy fatigability, change in sleeping patterns Irritability Appearing dazed Balance impairment Excessive crying Change in eating habits Loss of interest in favorite toys ===== Approach ===== ● Take a concussion-specific symptom survey including inquiries about H/A, N/V, light sensitivity, tinnitus, feeling like being in a fog, sleep disturbances ● History of diagnoses that might have an impact on the assessment or on a current concussion ○ History of prior concussions ○ H/A history ○ ADD/HD ○ Learning disabilities ○ Medications (prescribed and other) that might affect alertness or cognition ● Perform a good general neurological exam ● Include a concussion specific neuro exam ○ Check orientation ○ Assess for amnesia and impaired verbal memory ○ Balance: Romberg test (look for significant sway or breaking stance), single-leg stance ○ Eye movements: optokinetic nystagmus (OKN), smooth pursuit ○ Simultaneous task performance: e.g. snap fingers while walking ● Include assessment aides (“sideline tools”) as appropriate. ===== Assessment aids ===== ● There is no single validated assessment tool for diagnosis of concussion. ((Scorza KA, Raleigh MF, O'Connor FG. Current con- cepts in concussion: evaluation and management. Am Fam Physician. 2012; 85:123–132)) It is primarily a clinical diagnosis that is ideally made by certified healthcare providers who are familiar with the patient based on a detailed history and physical examination and a continuum of evaluation from the sideline to the clinic (diagnosis is ideally made within 24 hours of injury) ((Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine posi- tion statement: concussion in sport. Br J Sports [22] Med. 2013; 47:15–26)) ((McCrory P, Meeuwisse WH, Aubry M, et al. [23] Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013; 47:250–258 [24])) ((Scorza KA, Raleigh MF, O'Connor FG. Current con- cepts in concussion: evaluation and management. Am Fam Physician. 2012; 85:123–132)) ((McCrory P, Meeuwisse WH, Echemendia RJ, et al. What is the lowest threshold to make a diagnosis of [25] concussion? Br J Sports Med. 2013; 47:268–271)) ((Putukian M, Raftery M, Guskiewicz K, et al. Onfield [26] assessment of concussion in the adult athlete. Br J Sports Med. 2013; 47:285–288)) ((Giza CC, Kutcher JS, Ashwal S, et al. Summary of evi- dence-based guideline update: evaluation and ma- [27] nagement of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013; [28] 80:2250–2257)). ● Diagnosis may be aided by concussion assessment tools such as the SCAT3, ImPACTTM. ✖ No test has shown high validity on independent testing, and no test should be used as the sole method of diagnosing concussion or for determining suitability for return to play. Athletes have also learned to “game” some baseline tests to avoid removal from play after possible concussion ● SCAT3 (Sports Concussion Assessment Tool – 3rd Edition)12: Derived from the 2012 Zurich Conference.3 The SCAT has become the most commonly used standardized tool for sideline assessment of sport concussion. The sensitivity and specificity of concussion assessment tools change over the course of a concussion so a tool designed for sideline use (i.e. SCAT3) is not appropriate for office use ○ SCAT3TM is a trademarked tool developed by the Concussion in Sports Group for use only by medical professionals for assessing sports-related concussion ○ It can be found at http://bjsm.bmj.com/content/47/5/259.full.pdf ○ To be used in athletes of 13 years or older (for 12 and younger, use Child SCAT3 ((Child SCAT3. Br J Sports Med. 2013; 47)) ○ Is a multimodal assessment tool with 8 sections that include self-reported symptoms and evaluation of functional domains such as cognition, memory, balance, gait and motor skills ○ Takes 8–10 min to administer ○ A “normal” SCAT3 does not rule out a concussion ○ It has not been validated ● Other types of sports concussion assessment tools (many can be viewed on YouTube): ○ Neurocognitive testing (may take up to 20 minutes to administer) ○ SAC (Standardized Assessment of Concussion) ((McCrea M, Kelly JP, Kluge J, et al. Standardized Assessment of Concussion in Football Players. [33] Neurology. 1997; 48:586–588)) : a neurocognitive test that includes tests of immediate memory, delayed recall, serial 7’s, digit span ○ ImPACTTM (Immediate Post-Concussion Assessment and Cognitive Testing): a widely used commercially produced computer test (https://www.impacttest.com). Independent validation studies have yielded conflicting results and results can diverge from observations 15 ○ PCSS (Post-Concussive Symptom Scale) ○ CSI (Concussion Symptom Inventory) ○ BESS (Balance Error Scoring System): the subject stands in each of various standardized positions for 20 seconds each, and the number of errors is recorded (breaking stance, opening eyes, taking hands off the hip...). ○ SOT (Sensory Organization Test) ○ “Concussion Quick Check” app for mobile devices produced by the AAN ○ King-Devick eye movement testing: only takes 2–3 minutes to administer. On printed cards or tablet computer (http://kingdevicktest.com/for-concussions/) ● Formal neuropsychological testing: it is recommended that this be reserved for patients with pro- longed cognitive symptoms ===== Concussion biomarkers ===== [[Concussion biomarkers]]. ===== References ===== concussion_diagnosis.txt Last modified: 2025/05/13 02:01by 127.0.0.1