An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review

Abstract

Background Concussion in sport is an ongoing global concern. The head injury assessment (HIA) by the field of play is acknowledged as the first step in recognising and identifying concussion. While previous systematic literature reviews have evaluated the sensitivity of side-line screening tools and assessment protocols, no systematic review has evaluated the research designs and assessments used in a field setting. This systematic review investigated existing screening and diagnostic tools used in research as part of the HIA protocol to identify concussion that are currently used in professional, semi-professional and amateur (club) sports settings. Methods A systematic searching of relevant databases was undertaken for peer-reviewed literature between 2015 and 2020. Results Twenty-six studies met the inclusion criteria. Studies were of moderate to good quality, reporting a variety of designs. The majority of studies were undertaken in professional/elite environments with medical doctors and allied health practitioners (e.g., physical therapists) involved in 88% of concussion assessments. While gender was reported in 24 of the 26 studies, the majority of participants were male (77%). There was also a variety of concussion assessments (n = 20) with the sports concussion assessment tool (SCAT) used in less than half of the included studies. Conclusion The majority of studies investigating concussion HIAs are focused on professional/elite sport. With concussion an issue at all levels of sport, future research should be directed at non-elite sport. Further, for research purposes, the SCAT assessment should also be used more widely to allow for consistency across studies.

In-Season Test–Retest Reliability of Visual Smooth-Pursuit (EyeGuide Focus) Baseline Assessment in Female and Male Field-Sport Athletes

“…Research has also identified that variables such as exertion [ 13 , 14 ], learning effects [ 15 ], or attention deficit hyperactivity disorder (ADHD) [ 16 ] can have confounding effects on such tools. For these reasons, it is currently advised that a multi-modal assessment such as the Concussion in Sport Group’s (CISGs) Sport Concussion Assessment Tool (SCAT) [ 17 ] be used to better detect SRCs [ 18 ]. However, each of these methodologies requires medical professionals to administer, which can be time-intensive for those not specialized in sports medicine [ 19 ].…”

Nutritional Considerations of Irish Performance Dietitians and Nutritionists in Concussion Injury Management

“…Both (SRC and mTBI) share subjective presentations [ 8 , 9 ] and are often used interchangeably, particularly in the sporting context [ 2 ]. Improvements in technology, education, and concussion identification protocols [ 10 ] have led to an increase in the reporting of SRC incidents [ 11 , 12 ], though many are still going unreported or undiagnosed [ 13 , 14 ].…”

“…), which typically have limited medical field side support. This situation increases the risk of SRCs going undetected or undiagnosed and athletes’ exposure to RHIs [ 10 ]. Scullion et al [ 30 ] identified that players and coaches in amateur sports may have limited knowledge and training regarding SRC, in contrast to those in professional or elite team settings [ 30 ].…”

Reliability of a Smooth Pursuit Eye-Tracking System (EyeGuide Focus) in Healthy Adolescents and Adults

“…Consequently, there is increasing discussion and emerging evidence of the benefits of utilizing supplementary markers within the concussion assessment protocols [ 8 , 9 , 10 ]. Incorporation of assessments such as eye-movement testing provides objective screening to assist sports club medical staff who may suspect a concussion, or during the recovery phase after a sport-related concussion [ 11 , 12 ].…”