Concussion Assessment Tool Accurate for Use in Children

Jennifer Garcia

Disclosures

July 26, 2017

The Sport Concussion Assessment Tool version 3 (SCAT3) and the child version (ChildSCAT3) can accurately identify concussion in children, according to a new study published online July 26 in Pediatrics.

The study "provides valuable insight into the validity of SCAT3 and ChildSCAT3, which will be critical for the development of pending iterations of the tools," Franz E. Babl, MD, from The Royal Children's Hospital Melbourne, Parkville; Murdoch Children's Research Institute, Melbourne; and the University of Melbourne, all in Victoria, Australia, and colleagues, write.

As part of a prospective observational study, the researchers used the SCAT3 and ChildSCAT3 in children in the emergency department clinically diagnosed with concussion (CONC; n = 90) vs a control group consisting of well children (Well; n = 84) and those being evaluated for upper-limb injury (ULI; n = 90). They divided patients into subgroups in three age bands of 5 to 8, 9 to 12, and 13 to 16 years.

Children aged 5 to 12 years were evaluated with ChildSCAT3 and children 13 to 16 years were evaluated with SCAT3. The study excluded patients with major lower-limb injuries, multiple injuries, or a Glasgow coma score less than 15 at the time of assessment.

Overall symptom number and severity were rated higher among children in the CONC group compared with those in the ULI and Well groups (P < .001).  In addition, they found no significant differences between the control groups.

The SCAT3 and ChildSCAT3 include evaluation in the following five domains: symptom assessment, cognitive assessment (attention and new learning) by using the standardized assessment of concussion (SAC) and the SAC child version (SAC-C), neck examination, balance assessment (modified balance error scoring system), and coordination examination.

The authors point out that the "ChildSCAT3 includes age-appropriate modification of the…SAC and inclusion of a parent symptom report" but acknowledge that aspects of the test may be more applicable in the subacute recovery period.

Because the test was administered at only a single, early time point, its accuracy in identifying delayed symptoms remains unclear, they explain. Further, evaluation of the test among a more diverse group of patients (eg, non–English-speaking) is required. 

"To date, limited research has considered the validity of the SCAT3 and ChildSCAT3 in children despite their widespread dissemination and use," the authors write.

"Given the nonspecific nature of many concussion symptoms, the present findings provide important evidence to support the validity of both SCAT3 and ChildSCAT3 to distinguish children who have experienced a concussion from those with other common pediatric injuries (ie, ULIs) at acute presentation," conclude the study authors.

The Murdoch Children's Research Institute in Melbourne and the Victorian Government Research Infrastructure Support program provided funding for this study. The authors have disclosed no relevant financial relationships.  

Pediatrics. Published online July 26, 2017. Abstract

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