SCAT Symptom Recall Bias in Concussed Athletes

Abstract

Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion Assessment Tool (SCAT). The purpose of this study was to evaluate whether concussed athletes accurately recalled baseline functioning. Methods A retrospective cohort analysis of University football student-athletes from 2014-16 seasons was conducted. Forty-six student-athletes (M=19.7, SD=1.8) who suffered a concussion during the competitive season underwent a post-concussion assessment with a sports medicine physician within 24 hours of injury. Assessments included use of the symptom report from The SCAT3. Athletes were asked to recall their pre-injury baseline functioning. Results Of the 46 athletes who underwent assessments, 22 reported having at least 1 symptom (M=1.4, SD=2.0) at baseline evaluations. Yet at the initial medical evaluation, only 10 of these athletes correctly recalled having symptoms prior to injury, and none of them accurately reported their total symptom report. Paired t-tests revealed significant differences between an athletes predicted recall of the number of symptoms (M=0.7, SD=1.2) and total symptom scores (M=2.1, SD=3.4) conditions; t(45)=-3.28, p=.002, d=0.48. Conclusion Having accurate information for diagnosing concussions is important during concussion medical evaluations. Many clinicians depend on an athlete’s subjective reporting of symptom change. Our results indicate that an athlete’s accuracy of pre-injury functioning is poor, consistent with what has been termed “the good old days bias.” The findings suggest having baseline assessments can be helpful and clinicians may need to carefully understand an athletes pre-morbid functioning.

Reducing the Price of Naïveté in return‐to‐play from sports‐related concussion

“…In other words, it is easier for the patient to remember what symptoms he reported (e.g., by reviewing past medical records) than the symptoms he actually experienced. This assumption applies when a patient's recall of medical history has low reliability or accuracy, as was found in athletes with SRC (Arends et al., 2019; Kerr et al., 2015). We test the practical implications of this assumption in EC.6.6 in the Supporting Information.…”

A Novel Neuropsychological Tool for Immersive Assessment of Concussion and Correlation with Subclinical Head Impacts

“…In an effort to better identify potentially concussed individuals immediately after head injury, standard symptom checklists and dynamic physical assessments have been utilized, with varying degrees of success. 13,14 Currently, the Sport Concussion Assessment Tool (SCAT), 5th edition, is recommended for assessment in the first 24 h following concussion. 15 The SCAT has excellent sensitivity and specificity, yet requires a trained healthcare professional for administration and interpretation.…”