SAFETYLIT WEEKLY UPDATE

We compile citations and summaries of about 400 new articles every week.
RSS Feed

HELP: Tutorials | FAQ
CONTACT US: Contact info

Search Results

Journal Article

Citation

Fuller GW, Tucker R, Starling L, Falvey E, Douglas M, Raftery M. Sports Med. Open 2020; 6(1): e2.

Affiliation

World Rugby, World Rugby House 8-10 Lower Pembroke Street, Dublin, Dublin 2, Ireland.

Copyright

(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1186/s40798-019-0231-y

PMID

31919687

Abstract

BACKGROUND: Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized.

METHODS: A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments.

RESULTS: One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6-80.6) and a specificity of 86.6% (95% CI 83.7-89.1) for concussion (AUROC 0.82, 95% CI 0.79-0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, pā€‰<ā€‰0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, pā€‰<ā€‰0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value.

CONCLUSIONS: These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance.


Language: en

Keywords

Concussion; Diagnostic accuracy; Rugby; Screening

NEW SEARCH


All SafetyLit records are available for automatic download to Zotero & Mendeley
Print