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. 2017 Jun;51(11):903-918.
doi: 10.1136/bjsports-2016-097403.

What domains of clinical function should be assessed after sport-related concussion? A systematic review

Nina Feddermann-Demont  1   2   3 , Ruben J Echemendia  4   5 , Kathryn J Schneider  6   7   8 , Gary S Solomon  9 , K Alix Hayden  10 , Michael Turner  11 , Jiří Dvořák  2   12 , Dominik Straumann  1   2   3 , Alexander A Tarnutzer  1   2
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Free article

What domains of clinical function should be assessed after sport-related concussion? A systematic review

Nina Feddermann-Demont et al. Br J Sports Med. 2017 Jun.
Free article

Abstract

Background: Sport-related concussion (SRC) is a clinical diagnosis made after a sport-related head trauma. Inconsistency exists regarding appropriate methods for assessing SRC, which focus largely on symptom-scores, neurocognitive functioning and postural stability.

Design: Systematic literature review.

Data sources: MEDLINE, EMBASE, PsycINFO, Cochrane-DSR, Cochrane CRCT, CINAHL, SPORTDiscus (accessed July 9, 2016).

Eligibility criteria for selecting studies: Original (prospective) studies reporting on postinjury assessment in a clinical setting and evaluation of diagnostic tools within 2 weeks after an SRC.

Results: Forty-six studies covering 3284 athletes were included out of 2170 articles. Only the prospective studies were considered for final analysis (n=33; 2416 athletes). Concussion diagnosis was typically made on the sideline by an (certified) athletic trainer (55.0%), mainly on the basis of results from a symptom-based questionnaire. Clinical domains affected included cognitive, vestibular and headache/migraine. Headache, fatigue, difficulty concentrating and dizziness were the symptoms most frequently reported. Neurocognitive testing was used in 30/33 studies (90.9%), whereas balance was assessed in 9/33 studies (27.3%).

Summary/conclusions: The overall quality of the studies was considered low. The absence of an objective, gold standard criterion makes the accurate diagnosis of SRC challenging. Current approaches tend to emphasise cognition, symptom assessment and postural stability with less of a focus on other domains of functioning. We propose that the clinical assessment of SRC should be symptom based and interdisciplinary. Whenever possible, the SRC assessment should incorporate neurological, vestibular, ocular motor, visual, neurocognitive, psychological and cervical aspects.

Keywords: assessment; head trauma; preseason baseline testing; signs and symptoms; sports; systematic review.

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Conflict of interest statement

Competing interests: KJS has received speaking honoraria for presentations at scientific meetings. She is a physiotherapy consultant at Evidence Sport and Spinal Therapy and for many athletic teams. RJE is co-chair of the NHL/NHLPA Concussion Subcommittee, Chair of the MLS Concussion Committee, and a neuropsychological consultant to Princeton University and the US Soccer Federation. He receives financial compensation for each of these activities. He is engaged in the practice of clinical neuropsychology and occasionally serves as an expert in medico-legal cases involving TBI and SRC. He has received speaking honoraria for presentations at scientific meetings. GSS is a full-time employee of the Vanderbilt University Medical Center. He is a consulting neuropsychologist for the NHL Nashville Predators, NFL Tennessee Titans and several collegiate athletic teams, with all fees paid to institution. He is also a member of the ImPACT Scientific Advisory Board, and receives expense reimbursements for attendance at board meetings. He has received speaking honoraria for presentations at scientific meetings.

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