Review of Assessment Scales for Diagnosing and Monitoring Sports-related Concussion

Abstract

Sports-related concussion has emerged as a public health crisis due to increased diagnosis of the condition and increased participation in organized and recreational athletics worldwide. Under-recognition of concussions can lead to premature clearance for athletic participation, leaving athletes vulnerable to repeat injury and subsequent short- and long-term complications. There is overwhelming evidence that assessment and management of sports-related concussions should involve a multifaceted approach. A number of assessment criteria have been developed for this purpose. It is important to understand the available and emerging diagnostic testing modalities for sports-related concussions. The most commonly used tools for evaluating individuals with concussion are the Post-Concussion Symptom Scale (PCSS), Standard Assessment of Concussion (SAC), Standard Concussion Assessment Tool (SCAT3), and the most recognized computerized neurocognitive test, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The strengths and limitations of each of these tools, and the Concussion Resolution Index (CRI), CogSport, and King-Devick tests were evaluated. Based on the data, it appears that the most sensitive and specific of these is the ImPACT test. Additionally, the King-Devick test is an effective adjunct due to its ability to test eye movements and brainstem function.

Reliable sideline ocular-motor assessment following exercise in healthy student athletes

“…10 Currently, diagnosis relies heavily on subjective questionnaires and cognitive screening supporting physical examination and clinical judgement. 11 Recovery tracking generally monitors the severity of post-concussive symptoms over time. 10 The impact of exercise on such subjective assessments is unknown, making it difficult to interpret test results.…”

Incidence of Concussion and Head Impacts in Australian Elite-Level Male and Female Cricketers After Head Impact Protocol Modifications

“…The Cricket Australia Head Injury and Concussion Policy outlines that all head impacts are monitored and assessed for at least 24 hours postincident, including progressive symptom review and 24-hour follow-up computerized neurocognitive testing (CogSport). 1,2,6 Therefore, it was possible that a concussion diagnosis could be made at any of the following time points: soon after the head impact (immediate diagnosis), later in the game, or after the game (delayed diagnosis). The Cricket Australia Head Injury and Concussion Policy return-to-play criteria mandates that return to physical activity must not occur for at least 24 hours after concussion diagnosis, and our return-to-play process follows a staged progression similar to that described by the Berlin Concussion Consensus Statement.…”

<p>On-field assessment of concussion: clinical utility of the King-Devick test</p>

“…Poor oculomotor function is a reliable discriminator of mild traumatic brain injury (mTBI) due to impairment of both afferent and efferent visuomotor function 5,6. Afferent pathways include the optic nerve, white matter tracts, and visual cortices, while efferent pathways include cranial nerves responsible for normal eye movements and vestibular functioning 6.…”

“…The K-D test has been described as a means to assess saccadic eye movements, concentration, and attention 8. The K-D test was designed by Alan King and Steven Devick in the 1970s for evaluation of children suspected of dyslexia or impaired saccadic eye movements 5,9. Previously, it had also found use in studies of sleep-deprivation and reading ability in elementary school students 9.…”

“…Previously, it had also found use in studies of sleep-deprivation and reading ability in elementary school students 9. In recent years, its ease of use and potential for rapid administration in less than 2 minutes has made it a commonly used sideline tool for evaluation of suspected SRC 5. Research utilizing the K-D test has been performed in collegiate football players,10 collegiate soccer players,10 collegiate basketball players,10 amateur rugby players,11 professional ice hockey players,12 boxers,13 and mixed martial arts (MMA) fighters 13.…”