Bailey Christopher, Meyer Jessica, Soden Daniel, Tangen Christopher, Deane Ryan, Briskin Susannah, Gunstad John, Fastenau Philip, Smith Paul, Solomon Mary, Kelly Amanda Weiss
Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Arch Clin Neuropsychol. 2022 Oct 19;37(7):1536-1544. doi: 10.1093/arclin/acac007.
This study evaluated sex differences in performance on the Sport Concussion Assessment Tool-5 (SCAT5) Standardized Assessment of Concussion (SAC) and in baseline SCAT5 symptom reporting. It established clinically relevant cut points for low performance on the SAC based on both reliable chance indices (RCIs) and normative performance. This study also evaluated the diagnostic utility of the sex-adjusted SCAT5 SAC for identification of suspected concussion in collegiate athletes.
In total, 671 uninjured collegiate athletes were administered the SCAT5 and 264 of these athletes also completed SCAT5 testing ~1 year later. Fifty-four athletes were administered the SCAT5 after being removed from play due to suspected concussion. Sex differences in cognitive performance and symptom reporting at baseline were evaluated and sex-specific clinically relevant cut points were provided. Chi square and logistic regression models were used to evaluate if SAC performance was a significant predictor of concussion status.
Female athletes outperformed male athletes on the SCAT 5 SAC and showed minimally higher symptom endorsement. Use of sex-corrected normative data improved performance of the SAC in identification of suspected concussion when a low score cut point was used. Logistic regression models showed that sex-corrected SAC change from baseline (RCI) improved the predictive value of the model after first accounting for other elements of the SCAT5.
Present results support the use of sex-specific normative data for the SCAT5 SAC, particularly if using low performance without comparison to a baseline; however, reliable change from a pre-injury baseline may have somewhat higher diagnostic utility.
本研究评估了在运动性脑震荡评估工具-5（SCAT5）的标准化脑震荡评估（SAC）中表现的性别差异以及SCAT5基线症状报告中的性别差异。基于可靠概率指数（RCI）和正常表现，确定了SAC低表现的临床相关切点。本研究还评估了性别调整后的SCAT5 SAC在识别大学生运动员疑似脑震荡方面的诊断效用。
总共671名未受伤的大学生运动员接受了SCAT5测试，其中264名运动员在约1年后也完成了SCAT5测试。54名运动员在因疑似脑震荡被换下场后接受了SCAT5测试。评估了基线时认知表现和症状报告的性别差异，并提供了性别特异性的临床相关切点。使用卡方检验和逻辑回归模型来评估SAC表现是否是脑震荡状态的显著预测指标。
在SCAT 5 SAC中，女性运动员的表现优于男性运动员，并且症状认可略高。当使用低分数切点时，使用性别校正的正常数据可提高SAC在识别疑似脑震荡方面的表现。逻辑回归模型显示，在首先考虑SCAT5的其他因素后，性别校正后的SAC相对于基线的变化（RCI）提高了模型的预测价值。
目前的结果支持在SCAT5 SAC中使用性别特异性的正常数据，特别是在不与基线进行比较而使用低表现的情况下；然而，与伤前基线相比的可靠变化可能具有更高的诊断效用。
