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What domains of clinical function should be assessed after sport-related concussion? A systematic review
  1. Nina Feddermann-Demont1,2,3,
  2. Ruben J Echemendia4,5,
  3. Kathryn J Schneider6,7,8,
  4. Gary S Solomon9,
  5. K Alix Hayden10,
  6. Michael Turner11,
  7. Jiří Dvořák2,12,
  8. Dominik Straumann1,2,3,
  9. Alexander A Tarnutzer1,2
  1. 1 Department of Neurology, University Hospital Zurich, Zurich, Switzerland
  2. 2 Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
  3. 3 University of Zurich, Zurich, Switzerland
  4. 4 Department of Psychology, University of Missouri, Kansas City, Missouri, USA
  5. 5 Psychological and Neurobehavioral Associates, Inc. State College, Pennsylvania, USA
  6. 6 Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  7. 7 Alberta Children's Hospital, Research Institute, Calgary, Alberta, Canada
  8. 8 Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
  9. 9 Departments of Neurological Surgery, Orthopaedic Surgery & Rehabilitation, and Psychiatry & Behavioral Sciences, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  10. 10 Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
  11. 11 The International Concussion and Head Injury Research Foundation, London, UK
  12. 12 Department of Neurology, Spine Unit, Schulthess Clinic, Zurich, Switzerland
  1. Correspondence to Dr Nina Feddermann-Demont, Swiss Concussion Center, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland; nina.feddermann{at}swissconcussion.com

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.

  • sports
  • head trauma
  • signs and symptoms
  • assessment
  • preseason baseline testing
  • systematic review

https://doi.org/10.1136/bjsports-2016-097403

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    Footnotes

    • Contributors NFD conceived the study, designed the search strategy, selected suitable articles, extracted and analysed the data, drafted the manuscript and approved the final version of the manuscript.

      JD reviewed the initial search strategy, critically reviewed the manuscript and approved the final version. KJ

      S reviewed the initial search strategy and data extraction, determined level of evidence, critically reviewed the manuscript and approved the final version.

      MT reviewed the initial search strategy, critically reviewed the manuscript and approved the final version.

      RJE reviewed the initial search strategy, critically reviewed the manuscript and approved the final version of the manuscript.

      AH designed and reviewed the search strategy, performed study search and approved the final version of the manuscript.

      GSS critically reviewed the manuscript and approved the final version.

      DS reviewed the initial search strategy, critically reviewed the manuscript and approved the final version.

      AAT selected suitable articles, supported data analysis, supported in drafting of the manuscript and approved the final version of the manuscript.

    • 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.