Sideline Concussion Assessment: The Current State of the Art

Abstract

More than 200 million American adults and children participate in organized physical activity. Growing awareness has highlighted that concussion, especially when repeated, may be associated with prolonged neurological, cognitive, and/or neuropsychiatric sequelae. Objective diagnosis of concussion remains challenging. Although some concussion symptoms may be apparent even to nonmedical observers, diagnosis and removal from play for evaluation depend on validated assessment tools and trained, vigilant healthcare personnel. Over the past 2 decades, sideline concussion measures have undergone significant revision and augmentation to become more comprehensive batteries in order to detect a wide spectrum of symptomatology, eg, neurocognitive function, postconcussive symptoms, gait/balance, and saccadic eye movements. This review summarizes the current state-of-the-art concussion evaluation instruments, ranging from the Sports Concussion Assessment Tool (SCAT) and tools that may enhance concussion detection, to near-term blood-based biomarkers and emerging technology (eg, head impact sensors, vestibulo-ocular/eye-tracking, and mobile applications). Special focus is directed at feasibility, utility, generalizability, and challenges to implementation of each measure on-field and on the sidelines. This review finds that few instruments beyond the SCAT provide guidance for removal from play, and establishing thresholds for concussion detection and removal from play in qualification/validation of future instruments is of high importance. Integration of emerging sideline concussion evaluation tools should be supported by resources and education to athletes, caregivers, athletic staff, and medical professionals for standardized administration as well as triage, referral, and prevention strategies. It should be noted that concussion evaluation instruments are used to assist the clinician in sideline diagnosis, and no single test can diagnose concussion as a standalone investigation.

Brain Vital Signs in Elite Ice Hockey: Towards Characterizing Objective and Specific Neurophysiological Reference Values for Concussion Management

“…Recently, machine learning techniques have demonstrated high sensitivity to logistic classification of injury status based on single or multimodal assessments ( Jacquin et al, 2018 ; Boshra et al, 2019 ; Bazarian et al, 2021 ). While further validation and integration is required, there is an increasing urgency to develop portable, practical medical technologies based on these scientific findings to better enable point-of-care evaluations ( Smith et al, 2017 ; Yue et al, 2020 ).…”

“…Group A: Male elite ice hockey players ( N = 58; Age: 16.24 ± 0.76 years) were studied. Fifty-one ( Yue et al, 2020 ) were from North America (Canada: 29, United States: 22) and seven from Europe (Sweden: 3; Switzerland: 1; Finland: 1; Slovakia: 2). Forty-three ( Nakata et al, 2010 ) were fluent English speakers.…”

Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high‐level football

“…The off‐field assessment should focus on red and orange flags (Figure 3). Testing of ocular motor function should be included, since many of the pathways in the brain potentially affected by head injuries are involved in ocular motor control 42‐44 . Obvious minor injuries, such as lacerations or bruises, might be treated.…”

King-Devick Test Performance and Cognitive Dysfunction after Concussion: A Pilot Eye Movement Study

“…Sideline diagnostic tests [ 10 ] include the Sports Concussion Assessment Tool (SCAT) Symptom Checklist [ 11 , 12 ], Standardized Assessment of Concussion (SAC) [ 13 ], Balance Error Scoring System (BESS) [ 14 ], Vestibular–Ocular Motor Screening (VOMS) test [ 15 ], and rapid automatized naming tests such as the King-Devick (KD) test of number-naming [ 16 ] and the Mobile Universal Lexicon Evaluation System (MULES) test of picture-naming [ 17 ]. These diagnostic tests are also increasingly utilized in the outpatient setting where concussions often arise from non-sports-related injuries and where long-lasting symptoms are common [ 18 , 19 ].…”