SCAT5 Sex Differences: Normative Data, Clinical Thresholds, and Relevance for Identification of Concussion

Abstract

Objective This study evaluated sex differences in performance on the Sport Concussion Assessment Tool–5 (SCAT5) Standardized Assessment of Concussion (SAC) and in baseline SCAT5 symptom reporting. It established clinically relevant cut points for low performance on the SAC based on both reliable chance indices (RCIs) and normative performance. This study also evaluated the diagnostic utility of the sex-adjusted SCAT5 SAC for identification of suspected concussion in collegiate athletes. Method In total, 671 uninjured collegiate athletes were administered the SCAT5 and 264 of these athletes also completed SCAT5 testing ~1 year later. Fifty-four athletes were administered the SCAT5 after being removed from play due to suspected concussion. Sex differences in cognitive performance and symptom reporting at baseline were evaluated and sex-specific clinically relevant cut points were provided. Chi square and logistic regression models were used to evaluate if SAC performance was a significant predictor of concussion status. Results Female athletes outperformed male athletes on the SCAT 5 SAC and showed minimally higher symptom endorsement. Use of sex-corrected normative data improved performance of the SAC in identification of suspected concussion when a low score cut point was used. Logistic regression models showed that sex-corrected SAC change from baseline (RCI) improved the predictive value of the model after first accounting for other elements of the SCAT5. Conclusions Present results support the use of sex-specific normative data for the SCAT5 SAC, particularly if using low performance without comparison to a baseline; however, reliable change from a pre-injury baseline may have somewhat higher diagnostic utility.

Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review

“…The 10-item word list, but not concentration (digits backward plus months in reverse), differentiated concussed and non-concussed professional hockey players within 1 day of injury 60. The 10-item word list version of the SAC composite similarly differentiated concussed collegiate athletes and controls shortly after injury 62. In both studies, SCAT5 cognitive subtests accounted for unique variance in concussion diagnosis above symptom report alone.…”

“…One paper did show that for the 5-item word list delayed recall portion of the SCAT2, control athletes improved their performance significantly over baseline (consistent with a practice effect), whereas the concussed group did not show an improvement 20. One paper found that using SCAT5 SAC reliable change metrics improved diagnostic sensitivity over the use of normative data alone62 and another study applying machine learning algorithms found that using SAC baseline data outperformed the use of SAC normative cut-offs when classifying athletes diagnosed with concussion 55…”

“…Test characteristics/psychometrics —Eight studies examining SRC also presented normative data on the SCAT5 in collegiate,27 62 64 high school,65 and professional athletes,66–69 and found differences based on age, sex, health status, and language preference—underscoring the importance of using well-developed stratified norms. The 10-item word list of the SCAT5 exhibits improved psychometric properties over the 5-item word list, which shows ceiling effects 70.…”

“…Five studies published test–retest reliability for SCAT5 subtests. Test–retest reliability for component and total SAC scores was poor, ranging between 0.22 and 0.52 61 62 71–73. Base rates enable the quantitative interpretation of multiple tests simultaneously, reducing the risk of false-positive results.…”

Sleep Problems After Concussion Are Associated With Poor Balance and Persistent Postconcussion Symptoms

“…18,19 Another component of the Sports Concussion Assessment Tool–5 assesses neurocognitive function through a battery of memory tasks as a useful way to screen for concussion by using sex-specific normative data. 20 Further, shorter sleep duration acutely postconcussion has been previously associated with worsened reaction times, 21 potentially implying a connection between sleep problems and both motor and cognitive impairment following concussion. Exploring the relationship among postconcussion postural instability, cognitive function, and sleep problems is important because it provides an opportunity to understand the physical and mental effects of sleep problems and potential areas for intervention.…”