Patient Characteristics Predictive of Immediate and Delayed Word Recall Performance Following Adolescent Concussion

Abstract

Clinicians rely on objective concussion assessments that may be influenced by patient characteristics, creating difficulties in isolating the effect of concussion on patient function. The purpose of our study was to identify characteristics associated with performance on the Sport Concussion Assessment Tool 5^th edition (SCAT5) 10-word recall test following adolescent concussion. We evaluated patients seen for care within 14 days of concussion (n=125; 15.2±1.6 years of age, range=11–18 years; 46% female; 6.9±3.4 days post-concussion). Patient demographic (age, sex, medical and concussion history, etc.), injury (timing of presentation, symptom severity, sport-type, etc.), and clinical test (Modified Balance Error Scoring System [mBESS], tandem gait) characteristics were assessed, in addition to SCAT5 immediate and delayed memory testing using the 10-word recall list. Immediate and delayed recall performance was significantly associated with concussion symptom burden and cognitive accuracy during tandem gait, although effect sizes were notably small. Specific variables such as age, sex, diagnosis of ADD/ADHD, and performance on other clinical assessments were not significantly associated with recall performance after controlling for covariates. Further, the 10-word recall list demonstrates specific advantages over previously used 5-word lists by way of decreased ceiling effects and reduced interference of inherent patient characteristics.

Key words

mTBI - pediatric - memory - cognition - SCAT5 - determinants

Publication History

Received: 12 April 2022

Accepted: 11 September 2022

Accepted Manuscript online:
12 September 2022

Article published online:
11 November 2022

• References

• 1 McCrory P, Meeuwisse W, Dvorak J. et al. Consensus statement on concussion in sport: The 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017; 51: 838-847
• 2 Bryan MA, Rowhani-Rahbar A, Comstock RD. et al. Sports- and recreation-related concussions in US youth. Pediatrics 2016; 138: e20154635
• 3 McCrory P, Johnston K, Meeuwisse WH. et al. Summary and agreement statement of the 2nd international conference on concussion in sport, Prague 2004. Br J Sports Med 2005; 39: i78-i86
• 4 McCrea M, Kelly JP, Randolph C. et al. Standardized assessment of concussion (SAC): On-site mental status evaluation of the athlete. J Head Trauma Rehabil 1998; 13: 27-35
• 5 McCrory P, Meeuwisse WH, Aubry M. et al. Consensus statement on concussion in sport: The 4th international conference on concussion in sport held in Zurich, November 2012. Br J Sports Med 2013; 47: 250-258
• 6 McCroy P, Meeuwisee WH, Aubry M. et al. Sport concussion assessment tool – 3rd edition. Br J Sports Med 2013; 47: 259
• 7 Snedden TR, Brooks MA, Hetzel S. et al. Normative values of the sport concussion assessment tool 3 (SCAT3) in high school athletes. Clin J Sport Med 2017; 27: 462-467
• 8 Echemendia RJ, Meeuwisse WH, McCrory P. et al. The sport concussion assessment tool 5th edition (SCAT5). Br J Sports Med 2017; 51: 848-850
• 9 Black AM, Miutz LN, Kv VW. et al. Baseline performance of high school rugby players on the sport concussion assessment tool 5. J Athl Train 2020; 55: 116-123
• 10 Norheim N, Kissinger-Knox A, Cheatham M. et al. Performance of college athletes on the 10-item word list of SCAT5. BMJ Open Sport Exerc Med 2018; 4: e000412
• 11 Fuller GW, Raftery M. Sport concussion assessment tool – fifth edition normative reference values for professional rugby union players. Clin J Sport Med 2018; 30: e150-e153
• 12 McCrea M, Kelly JP, Kluge J. et al. Standardized assessment of concussion in football players. Neurology 1997; 48: 586-588
• 13 Chin EY, Nelson LD, Barr WB. et al. Reliability and validity of the sport concussion assessment tool–3 (SCAT3) in high school and collegiate athletes. Am J Sports Med 2016; 44: 2276-2285
• 14 Benedict PA, Baner NV, Harrold GK. et al. Gender and age predict outcomes of cognitive, balance and vision testing in a multidisciplinary concussion center. J Neurol Sci 2015; 353: 111-115
• 15 Cook NE, Kelshaw PM, Caswell SV. et al. Children with attention-deficit/hyperactivity disorder perform differently on pediatric concussion assessment. J Pediatr 2019; 214: 168-174
• 16 Bunt SC, Didehbani N, Tarkenton T. et al. Sex differences and reporting of SCAT-5 concussion symptoms in adolescent athletes. Clin J Sport Med 2021; 31: e229-e234
• 17 Shanks MJ, McCrory P, Davis GA. et al. Developing common demographic data elements to include in future editions of the SCAT and child SCAT: A modified international delphi study. Br J Sports Med 2020; 54: 906-912
• 18 Hajek CA, Yeates KO, Taylor HG. et al. Agreement between parents and children on ratings of post-concussive symptoms following mild traumatic brain injury. Child Neuropsychol 2011; 17: 17-33
• 19 Patsimas T, Howell DR, Potter MN. et al. Concussion-symptom rating correlation between pediatric patients and their parents. J Athl Train 2020; 55: 1020-1026
• 20 Howell DR, Brilliant AN, Meehan WP. Tandem gait test-retest reliability among healthy child and adolescent athletes. J Athl Train 2019; 54: 1254-1259
• 21 Howell DR, Wilson JC, Brilliant AN. et al. Objective clinical tests of dual-task dynamic postural control in youth athletes with concussion. J Sci Med Sport 2019; 22: 521-525
• 22 Oldham JR, Difabio MS, Kaminski TW. et al. Efficacy of tandem gait to identify impaired postural control after concussion. Med Sci Sports Exerc 2018; 50: 1162-1168
• 23 Brooks MA, Snedden TR, Mixis B. et al. Establishing baseline normative values for the child sport concussion assessment tool. JAMA Pediatr 2017; 171: 670-677
• 24 Wingerson MJ, Seehusen CN, Walker G. et al. Clinical feasibility and utility of a dual-task tandem gait protocol for pediatric concussion management. J Athl Train 2020; Online ahead of print. doi: DOI: 10.4085/323-20.