When college athletes are being assessed for a potential concussion, the diagnosis is determined by an athletic trainer or team physician evaluating the player’s symptoms, physical balance, and cognitive skills.
New research released today indicates that nearly 50% of athletes who later receive a diagnosis of concussion will perform normally on the recommended cognitive skills test.
“If you don’t score well on the cognitive test, it indicates that you have a concussion. However, many concussed individuals perform well on the test,” stated Dr. Kimberly Harmon, the lead author of the study. Dr. Harmon serves as a professor of family medicine and the head of sports medicine at the University of Washington School of Medicine.
The findings of the study are published in JAMA Network Open.
Dr. Harmon mentioned her personal experiences as a team physician for th
The UW Huskies made her question how to accurately interpret the cognitive-screening part of the Sport Concussion Assessment Tool (SCAT). Created in 2004 by the Concussion in Sport Group, the SCAT (now in its fifth version, SCAT5) was designed to standardize the collection of information from athletes with a potential head injury.
The SCAT starts by asking an athlete if they are experiencing any of 22 symptoms such as headache, nausea, or blurred vision, and the severity of the symptoms. Then the tool assesses the athlete’s cognition in various ways.
First, there are questions about orientation. (What day is it? What month is it?) Then, aThe assessment involves testing the athlete’s immediate memory by reading a list of 10 words and asking them to repeat it three times. Then, the athlete’s concentration is tested by repeating sequences of numbers in reverse order. This is followed by an evaluation of the athlete’s balance, after which they are asked to recall the 10 words from the initial list. According to Harmon, some concussed individuals performed well on the recall tests, while some non-concussed individuals did not. This led her to believe that the tests should be reconsidered could look into it,” she stated.
A total of 92 NCAA Division I athletes who experienced a concussion between July 13, 2020, and Dec. 31, 2022, were included in the research. The players also recruited 92 teammates of the concussed players as control subjects, and each of them underwent the SCAT5 screening within two weeks of the concussion.
All athletes in the study had previously undergone baseline concussion screenings as required by the NCAA. The researchers found no significant disparities in baseline scores between the athletes with and without concussions.
Harmon and her team examinedThe researchers analyzed the SCAT5 responses of the study participants and discovered that the word-recall tests did not have much predictive value for concussion. Surprisingly, almost half (45%) of the concussed athletes performed at or above their baseline cognitive-test results, according to the researchers.
Instead, the study indicated that the most accurate predictor of concussion was the athletes’ responses to questions about their symptoms.
“If you get hit in the head and go to the sideline and say, ‘I have a headache. I’m dizzy. I don’t feel right,’ I can say with pretty good assurance that you have a concussion,” Harmon said. “I don’t need to do any testing. The problem is evident in your symptoms.”Some athletes are hesitant to disclose their symptoms and may not even realize they have symptoms. This makes it necessary to have an objective and accurate test to determine whether it is safe for the athlete to return to the game. Unfortunately, such a test is not currently available.”
During evaluations for a concussion during a game, the team’s trainers and doctors must quickly assess the evidence and use their best clinical judgment to determine the player’s health. However, the responsibility for making a safety-first decision also falls on the athletes, according to the authors of the study.The signs of a concussion are often difficult to detect, as it relies on the athlete reporting their symptoms accurately. Athletes may be hesitant to report their symptoms due to the desire to get back to playing, fear of letting down their teammates, downplaying the seriousness of their concussion, having trouble recognizing the symptoms, experiencing a delay in symptom development, or for other reasons.
“We still don’t have a foolproof way to objectively test for a concussion,” Harmon stated. “This study highlights the importance of athletes being open about their symptoms.”
The Jack and Luellen Cherneski and the Chisholm Foundation provided funding for the study.
