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. 2021 Sep-Oct;36(5):E302-E311.
doi: 10.1097/HTR.0000000000000648.

Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease

Atticus Coscia  1 , Uwe Stolz, Christopher Barczak, Natalie Wright, Stephan Mittermeyer, Tanzid Shams, Stephen Epstein, Natalie Kreitzer
Affiliations

Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease

Atticus Coscia et al. J Head Trauma Rehabil. 2021 Sep-Oct.

Abstract

Objective: The Sports Concussion Assessment Tool 3 (SCAT3) Symptom Evaluation (SE) is used in the emergency department (ED). This study aimed to examine the effects of psychiatric history on the SCAT3 SE symptom severity score (SSS).

Setting: Three US EDs.

Participants: A total of 272 ED patients with suspected concussion.

Design: Prospective, nonrandomized, nonblinded study. The SCAT3 SE SSS, demographic data, medical information, and self-reported psychiatric history were obtained from patients by clinical research staff when they presented to the ED seeking standard clinical care. Concussion diagnoses were determined following a comprehensive assessment by an ED physician trained in managing concussions and adjudicated by supervising physicians.

Main measures: The primary outcome measure was SSS. The association between SSS, self-reported psychiatric disease, and concussion diagnosis was analyzed using multivariable linear regression.

Results: 68.4% of subjects were diagnosed with a concussion. After controlling for age, sex, race, history of previous concussion, and interval from injury to ED presentation, self-reported psychiatric history (adjusted regression coefficient (βa): 16.9; confidence interval [CI]: 10.1, 23.6), and concussion diagnosis (βa: 21.7; CI: 14.2, 29.2) were both independently associated with a significant increase in SSS. Subjects with a history of concussion had a significantly higher SSS (βa: 9.1; CI: 1.8, 16.5). Interval from injury to ED presentation was also associated with a significant increase in SSS (βa: 1.6 per 6-hour increase; CI: 0.4, 2.8).

Conclusion: Our findings demonstrate that a history of preexisting psychiatric disease, as self-reported by patients with a suspected concussion treated in the ED, is independently associated with significantly higher scores on the SCAT3 SE. This suggests that a history of psychiatric illness may need to be accounted for when the SCAT3 SE is used in the ED for the assessment of concussion.

Trial registration: ClinicalTrials.gov NCT02812225.

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Conflict of interest statement

The authors declare no conflicts of interest.

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