The Sport Concussion Assessment Tool (SCAT2) for evaluating civilian mild traumatic brain injury. A pilot normative study

Abstract

Self-report measures, particularly symptom inventories, are critical tools for identifying patients with persistent post-concussion symptoms and their follow-up. Unlike in military or sports-related assessment, in general civilian settings pre-injury levels of concussion-like symptoms are lacking. Normative data are available in adolescent and college populations, but no reference data exist to guide clinical adult explorations. The purpose of this study was to use the second edition of the Sport Concussion Assessment Tool (SCAT2) to profile a cohort of 60 healthy community volunteers who had not sustained a head injury. Participating volunteers underwent MRI scanning and were evaluated with the Hospital Anxiety and Depression Scale (HADS). Participants reported a median of 3 concussion-like symptoms and the 97.5 percentile score was found at 10.5 symptoms, out of a total of 22. The median severity score was 4.9 points, and 28.9 was the upper limit of the reference interval. Only 10 participants (16.7%) did not endorse any symptom. The most frequently endorsed symptom was feeling difficulty in concentrating, with 41.7% of the sample reporting it. Age, sex and general distress, anxiety and depressive symptoms were not associated with concussion-like symptoms. Our data yielded elevated cut-offs scores for both the number of symptoms and the symptom severity. In conclusion, postconcussive-like symptoms are frequent in the general non-concussed adult population and it should be taken into account in any future models developed for screening patients at risk of developing physical, cognitive, and psychological complaints following mild traumatic injury.

Fig 1. Examples of MRI incidental findings.

Relevant details are marked with white arrowheads: A. Unspecific punctate lesion in a 21-year old male, in FLAIR. B. Multiple foci of white matter hyperintensity, corresponding to stage 1 on the Fazekas scale,[32] visible in the FLAIR scan in a 50-year old man. C. Venous angioma in a 58-year old man in a T2-weighted image.

Fig 2. Distribution of the number of symptoms and the symptom severity score in the cohort.

A. Histogram for the number of symptoms. B. Histogram for the symptom severity score C. Box-and-whiskers plot for the number of symptoms. D. Box-and-whiskers plot for the symptom severity score. The black lines inside the boxes are the median values for each group. The vertical size of the boxes is the interquartile range (IQR). The ‘whiskers’ represent the minimum and maximum values that do not exceed 1.5×IQR.