The clinical reaction time test as part of a standardised concussion assessment battery

[摘要] Background: Concussion is a worldwide challenge and diagnosing, evaluating andmonitoring injured athletes places a huge burden on even experienced clinicians. Eachconcussed athlete presents differently and each one should be treated individually. In anideal world, enough resources should be available for neuropsychologists andneuropsychology tests to evaluate each athlete. In resource-limited areas,neuropsychologists are replaced by experienced clinicians for treating concussions; theseclinicians use as many objective cognitive tests as are available. If computerisedneuropsychology tests are unavailable, then low-cost, objective and fast sideline tests, likethe clinical reaction time test, may be incorporated in the assessment battery protocol. Noone test can be the sole cognitive assessment for recovery after a concussion. Itis 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 tocompare 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 rugbyunion players who suffered concussion (n = 46, mean age 21, range 18 to 33 years) out of1 166 registered players were evaluated within 72 hours (Evaluation-1), then weekly(Evaluations 2 to 4) until they became asymptomatic (Evaluation-Asymptomatic) using theSCAT3 total score and RTClin tests.Results: Within the first 72 hours after a concussion the SCAT3 Score and the RTClinshowed a moderately positive correlation of 0.47 (Spearman test) and p = 0.04. TheSpearman 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 10to 74) with the asymptomatic evaluation (E- Asym, n = 14, mean 3.5, range 0 to 9) showsstatistical significance (p < 0.01). The RTClin during E-1 (n = 19, mean 190 ms, range 168 to258 ms) and, compared to E-Asym (n = 14, mean 179 ms, range 147 to 223 ms), cameclose to showing significance (p = 0.07).The recovery tracking showed the mean time for recovery as 6 days (n = 5, range 4 to 18days). 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 msand a mean difference of 20 ms. There is a strong correlation of SCAT3 Score and RTClinover time, of 0.80, but p > 0.05. The recovery time correlation for SCAT3 Score wasmoderate (-0.56), but p > 0.05, and for RTClin recovery showed a strong correlation overtime (-0.82), but also p > 0.05.Conclusions: In a low-resource environment with only clinical examinations, SCAT3 andRTClin as tools there is evidence that the SCAT3 Score and RTClin may be good sidelinediagnostic or screening tools within the first 72 hours after concussion. When athletesbecome asymptomatic, the RTClin becomes more important for monitoring persistentcognitive impairment than the SCAT3 Score. Further research is needed with larger studypopulations to confirm the utility of the RTClin as part of a post-concussion assessmentbattery.

[发布机构] University of the Free State