Prospective Clinical Assessment Using Sideline Concussion Assessment Tool-2 Testing in the Evaluation of Sport-Related Concussion in College Athletes

Objective: To evaluate the utility of the Sideline Concussion Assessment Tool (SCAT)-2 in collegiate athletes with sport-related concussion. Design: Prospective cross-sectional study with baseline testing and serial repeat testing after concussion in contact sport athletes and non-concussed control athletes. Setting: Division I University. Participants: Male and female club rugby and varsity athletes. Interventions: Baseline measures of concussion symptoms, cognitive function, and balance were obtained using the SCAT-2. Serial postinjury testing was conducted as clinically indicated. Main Outcome Measures: The SCAT-2 total and subset scores were calculated and evaluated at baseline and after injury. Results: The total SCAT-2 score and the composite scores of symptoms, symptom severity, and balance were significantly different in concussed groups after injury when compared with baseline. When comparing performance in concussed versus control athletes, all subcomponents of the SCAT-2 were significantly different. No differences in baseline SCAT-2 scores were seen based on self-reported history of concussion. At baseline, anxiety and depression screening scores were associated with higher symptom scores. When compared with baseline, a 3.5-point drop in SCAT-2 score had 96% sensitivity and 81% specificity in detecting concussion. When examined to exclude baseline scores, a cutoff value of 74.5 was associated with 83% sensitivity and 91% specificity in predicting concussion versus control status. Conclusions: The SCAT-2 total composite score and each sub-component are useful in the assessment of concussion. As SCAT-3 is similar to SCAT-2, it is expected that it too will be a useful tool.