Acute Sport-Related Concussion Screening for Collegiate Athletes Using an Instrumented Balance Assessment

Abstract

Context: Without a true criterion standard assessment, the sport-related concussion (SRC) diagnosis remains subjective. Inertial balance sensors have been proposed to improve acute SRC assessment, but few researchers have studied their clinical utility.

Objective: To determine if group differences exist when using objective measures of balance in a sample of collegiate athletes with recent SRCs and participants serving as the control group and to calculate sensitivity and specificity to determine the diagnostic utility of the inertial balance sensor for acute SRC injuries.

Design: Cross-sectional cohort study.

Setting: Multicenter clinical trial.

Patients or other participants: We enrolled 48 participants with SRC (age = 20.62 ± 1.52 years, height = 179.76 ± 10.00 cm, mass = 83.92 ± 23.22 kg) and 45 control participants (age = 20.85 ± 1.42 years, height = 177.02 ± 9.59 cm, mass = 74.61 ± 14.92 kg) at 7 clinical sites in the United States. All were varsity or club collegiate athletes, and all participants with SRC were tested within 72 hours of SRC.

Main outcome measure(s): Balance performance was assessed using an inertial balance sensor. Two measures (root mean square sway and 95% ellipse sway area) were analyzed to represent a range of general balance measures. Balance assessments were conducted in double-legged, single-legged, and tandem stances.

Results: A main effect for group was associated with the root mean square sway measure ( F_1,91 = 11.75, P = .001), with the SRC group demonstrating balance deficits compared with the control group. We observed group differences in the 95% ellipse sway area measure for the double-legged ( F_1,91 = 11.59, P = .001), single-legged ( F_1,91 = 6.91, P = .01), and tandem ( F_1,91 = 7.54, P = .007) stances. Sensitivity was greatest using a cutoff value of 0.5 standard deviations (54% [specificity = 71%]), whereas specificity was greatest using a cutoff value of 2 standard deviations (98% [sensitivity = 33%]).

Conclusions: Inertial balance sensors may be useful tools for objectively measuring balance during acute SRC evaluation. However, low sensitivity suggests that they may be best used in conjunction with other assessments to form a comprehensive screening that may improve sensitivity.

Keywords: Balance Error Scoring System; inertial sensor; mild traumatic brain injuries.

Figure

Distribution plots of participants with sport-related concussion and control participants for each balance metric using an inertial sensor. A and B, Root mean square sway. C and D, 95% Ellipse sway area: double-legged stance. E and F, 95% Ellipse sway area: single-legged stance. G and H, 95% Ellipse sway area: tandem stance. Continued on next page.

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