1University of Illinois Urbana-Champaign, Carle Illinois College of Medicine, Urbana.
2University of Illinois Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana.
Neurosurg Focus. 2024 Jul;57(1):E5. doi: 10.3171/2024.4.FOCUS24112.
In the United States, more than 1 million sport-related concussions afflict children annually, with many cases undetected or unreported. The Sport Concussion Assessment Tool (SCAT) is widely used to detect concussions in high school, collegiate, and professional sports. The objective of this study was to establish baseline values for the SCAT version 5 (SCAT5) in high school athletes.
Baseline SCAT5 evaluations were conducted in students (ages 14-19 years) from 19 high schools in central Illinois who were participating in various school-sponsored sports. The SCAT5 evaluations were retrospectively extracted from the electronic medical record system for analysis. Statistical analyses included the Wilcoxon rank-sum test for continuous variables and the chi-square test for categorical variables, considering significance at p < 0.05. Test-retest reliability at < 6 months, 10-14 months, and 16-20 months was computed using intraclass correlation and Spearman's rho (ρ). Reliable change indices are provided using the Iverson formula.
A total of 2833 unique athletes were included, and the average age was 15.5 ± 1.14 (SD) years. There were 721 female (25.5%) and 2112 male (74.5%) athletes. Students ≥ 15 years old had more prior concussions (p < 0.001), and male athletes were more frequently hospitalized for head injury (p = 0.013). Female athletes exhibited a significantly higher prevalence of mood disorders (14.7% vs 4.6%, p < 0.001), whereas attention-deficit/hyperactivity disorder was more common in male athletes (5.2% vs 13.2%, p < 0.001). Symptom number and severity were significantly greater in female athletes (3.17 ± 4.39 vs 2.08 ± 3.49, p < 0.001; 5.47 ± 9.21 vs 3.52 ± 7.26, p < 0.001, respectively), with mood-related symptoms representing the largest differences. Female athletes and students ≥ 15 years old performed better on most cognitive assessments. Female athletes and students < 15 years old performed better on the modified Balance Error Scoring System (p < 0.001). Test-retest reliability was poor to moderate for most assessment components. Reliable change index cutoff values differed slightly by sex, with female athletes often having a greater cutoff value.
This study underscores the variability of SCAT5 baseline values influenced by age, sex, and medical history among adolescent athletes. It provides a robust dataset, delineating baseline values stratified by sex and age within this demographic. Additionally, the results provide enhanced guidance to clinicians for interpretation of change and reliability of baselines.
在美国，每年有超过 100 万例与运动相关的脑震荡影响儿童，其中许多病例未被发现或报告。运动性脑震荡评估工具（SCAT）广泛用于检测高中、大学和职业体育中的脑震荡。本研究的目的是为高中运动员建立 SCAT5 版本 5（SCAT5）的基线值。
对来自伊利诺伊州中部 19 所高中参加各种学校赞助运动的 14-19 岁学生进行了基线 SCAT5 评估。通过电子病历系统回顾性提取 SCAT5 评估结果进行分析。统计分析包括连续变量的 Wilcoxon 秩和检验和分类变量的卡方检验，考虑 p < 0.05 的显著性。考虑到 6 个月内、10-14 个月和 16-20 个月的测试-重测可靠性，使用组内相关系数和斯皮尔曼 rho（ρ）进行计算。使用 Iverson 公式提供可靠变化指数。
共纳入 2833 名独特运动员，平均年龄为 15.5 ± 1.14（SD）岁。有 721 名女性（25.5%）和 2112 名男性（74.5%）运动员。≥15 岁的学生既往脑震荡发生率更高（p < 0.001），男性运动员因头部受伤住院治疗的比例更高（p = 0.013）。女性运动员表现出更高的情绪障碍患病率（14.7% vs 4.6%，p < 0.001），而注意力缺陷/多动障碍在男性运动员中更为常见（5.2% vs 13.2%，p < 0.001）。女性运动员的症状数量和严重程度明显更高（3.17 ± 4.39 vs 2.08 ± 3.49，p < 0.001；5.47 ± 9.21 vs 3.52 ± 7.26，p < 0.001，分别），情绪相关症状的差异最大。女性运动员和≥15 岁的学生在大多数认知评估中表现更好。女性运动员和<15 岁的学生在改良平衡错误评分系统上的表现更好（p < 0.001）。大多数评估成分的测试-重测可靠性差至中等。可靠变化指数的临界值因性别而异，女性运动员的临界值通常更高。
本研究强调了 SCAT5 基线值受青少年运动员年龄、性别和病史影响的可变性。它提供了一个强大的数据集，按性别和年龄在该人群中划分基线值。此外，结果为临床医生提供了更好的解释变化和基线可靠性的指导。
