The clinical reaction time test as part of a standardised concussion assessment battery
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Date
2016-02-12
Authors
Carstens, Charl Sarel von Willigh
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Background: Concussion is a worldwide challenge and diagnosing, evaluating and
monitoring injured athletes places a huge burden on even experienced clinicians. Each
concussed athlete presents differently and each one should be treated individually. In an
ideal world, enough resources should be available for neuropsychologists and
neuropsychology tests to evaluate each athlete. In resource-limited areas,
neuropsychologists are replaced by experienced clinicians for treating concussions; these
clinicians use as many objective cognitive tests as are available. If computerised
neuropsychology tests are unavailable, then low-cost, objective and fast sideline tests, like
the clinical reaction time test, may be incorporated in the assessment battery protocol. No
one test can be the sole cognitive assessment for recovery after a concussion. It
is imperative that all these clinical tests practical limitations and benefits are known.
Aims: This study’s primary aim was to compare the Sport Concussion Assessment Tool 3
(SCAT3) total score with the clinical reaction time test (RTClin). The secondary aim was to
compare the two tests as recovery tracking evaluations in the days following a concussion.
Methods: In one season (2014) a prospective cohort study of amateur collegiate rugby
union players who suffered concussion (n = 46, mean age 21, range 18 to 33 years) out of
1 166 registered players were evaluated within 72 hours (Evaluation-1), then weekly
(Evaluations 2 to 4) until they became asymptomatic (Evaluation-Asymptomatic) using the
SCAT3 total score and RTClin tests.
Results: Within the first 72 hours after a concussion the SCAT3 Score and the RTClin
showed a moderately positive correlation of 0.47 (Spearman test) and p = 0.04. The
Spearman correlation between asymptomatic athletes was poor (0.21 and p = 0.46).
A comparison of the SCAT3 Score of the first evaluation (E-1, n = 19, mean 24, range 10
to 74) with the asymptomatic evaluation (E- Asym, n = 14, mean 3.5, range 0 to 9) shows
statistical significance (p < 0.01). The RTClin during E-1 (n = 19, mean 190 ms, range 168 to
258 ms) and, compared to E-Asym (n = 14, mean 179 ms, range 147 to 223 ms), came
close to showing significance (p = 0.07).
The recovery tracking showed the mean time for recovery as 6 days (n = 5, range 4 to 18
days). The SCAT3 Score for E-1 showed a mean of 24, E-Asym mean of 3 and mean difference of 18. The RTClin for E-1 showed a mean of 199 ms, E-Asym mean of 178 ms
and a mean difference of 20 ms. There is a strong correlation of SCAT3 Score and RTClin
over time, of 0.80, but p > 0.05. The recovery time correlation for SCAT3 Score was
moderate (-0.56), but p > 0.05, and for RTClin recovery showed a strong correlation over
time (-0.82), but also p > 0.05.
Conclusions: In a low-resource environment with only clinical examinations, SCAT3 and
RTClin as tools there is evidence that the SCAT3 Score and RTClin may be good sideline
diagnostic or screening tools within the first 72 hours after concussion. When athletes
become asymptomatic, the RTClin becomes more important for monitoring persistent
cognitive impairment than the SCAT3 Score. Further research is needed with larger study
populations to confirm the utility of the RTClin as part of a post-concussion assessment
battery.
Description
Keywords
Dissertation (M.Sports.Med. (Sports Medicine))--University of the Free State, 2016, Sport injuries, Brain -- Concussion, Clinical neuropsychology, Sport injuries -- Patients -- Rehabilitation, Head -- Wounds and injuries -- Complications