Baseline Performance and Psychometric Properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5- to 13-year-old Athletes

Abstract

Objective To determine the normative, baseline performance and psychometric properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5-13 year-old athletes. Design Cross-sectional study. Setting Practice filds. Participants Contact sport athletes (N = 155) 5-13 years old. Independent Variables Age, gender, verbal intellectual functioning (receptive vocabulary) Main Outcome Measures Child-SCAT3: self- and parent-reported symptoms, cognitive performance (child form of the standardized assessment of concussion; SAC-C), and balance (modified balance error scoring system, mBESS-C; tandem gait). A subset of the sample repeated the Child-SCAT3 at another date. Some subjects also completed the Adult-SCAT3 version of the symptom checklist and mBESS. Results Small to medium-sized effects of age were observed on all Child-SCAT3 components. Effects of gender and receptive vocabulary were observed on select components of the SCAT3. Younger age and lower receptive vocabulary were independently associated with greater symptom endorsement, yet parents rated higher symptom burden for older children. Internal consistency reliability and stability of symptom ratings was good to excellent. Stability was more modest for SAC-C and tandem gait scores and very poor for mBESS-C scores, perhaps due to restricted variance. Interrater reliability (self- versus parent-rated symptoms) was fair. Conclusions The Child-SCAT3 self-report symptom checklist may be inappropriate to administer to younger school-aged children. Some of the age effects observed warrant use of demographically-appropriate norms in Child-SCAT3 interpretation. The findings can provide guidance for clinicians assessing children of varying ages and point to directions for further development of refined approaches for pediatric concussion assessment.

What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? A systematic review

“…Preliminary data suggest that many children are unable to report the date or correctly recite four digits backwards at baseline 34 37. Older age was predictive of a better score on all SAC-C measures 35. Sex is also associated with SCAT/ChildSCAT3 scores 19 34 35 38.…”

“…Normative values between the adult and child checklists were examined in 155 athletes between the ages of 5 and 13 years 35. Younger children reported more symptoms on the ChildSCAT3 than their older counterparts (10–13 years old), with older female athletes reporting more symptoms than younger female athletes.…”

“…Sex is also associated with SCAT/ChildSCAT3 scores 19 34 35 38. For example, Schneider et al 19 found better performance by females than males for months in reverse order and digits backwards using the SCAT, and Nelson et al 35 33 found that female sex was associated with a greater symptom burden with age using the ChildSCAT3. There are scant data assessing potential interactions between age and sex.…”

“…Normative data have been reported35 for the child version of the mBESS, which excludes single leg stance. Variable responses to balance assessment in children have been reported, with differences found by age,34 35 sex,34 35 stance39 and surface (hard vs foam).…”

Baseline Properties of the Sport Concussion Assessment Tool 3 (SCAT3) in Iranian Professional League Football Players

“…There are four articles published, evaluating baseline normative values but to the best of our knowledge, no study has evaluated the correlation between different factors and a history of concussion on elite level athletes (7,(12)(13)(14). For this reason, we also aimed to analyze different factors that might be affected by a history of concussion.…”