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3.6 Buffalo concussion physical exam score for predicting delayed recovery in adolescents
  1. Adam Cunningham1,
  2. Mohammad Haider2,
  3. Kenneth Aguirre2,
  4. Scott Darling3,
  5. Heidi Suffoletto2,4,
  6. Barry Willer2,4,
  7. John Leddy2
  1. 1Department of Biostatistics, University at Buffalo, SUNY, Buffalo, USA
  2. 2Department of Orthopedics and Sports Medicine, University at Buffalo, SUNY, Buffalo, USA
  3. 3Invision Health, Buffalo, USA
  4. 4Department of Psychiatry, University at Buffalo, SUNY, Buffalo, USA

Abstract

Objective Vestibulo-oculomotor impairments are common after concussion. The Buffalo Concussion Physical Exam (BCPE) is a brief, pertinent physical examination for helping to diagnose concussion. We derived a scoring algorithm to identify adolescents who may take longer to recover (>30 days) and may benefit from early specific therapy.

Design Retrospective cohort.

Setting University clinics.

Participants 263 adolescents diagnosed with concussion using international guidelines (14.92±1.9 years, 62% male, 90% sport-related, 6.0±4 days from injury).

Interventions (or Assessment of Risk Factors) BCPE was performed at the initial visit and weekly until recovery. We used a binomial generalized linear model with complementary log-log error function. Significant predictor variables were stepwise selected using Akaike Information Criterion, and k-fold cross-validation was used for internal validity.

Outcome Measures Days since injury (1-point/day), high-velocity/multiple impacts (2-points), >2 previous concussion (4-points), dizziness on postural change (5-points), abnormal vestibulo-ocular reflex (VOR, 5-points), abnormal tandem gait (1-point), high-velocity/multiple impact plus abnormal VOR (5-points), and dizziness on postural change plus abnormal VOR (minus 4-points) were used to categorize low (0–10), medium (11–15) and high (>15 points) risk.

Main Results The algorithm correctly identified 73% of normal recoverers as low-risk, 23% as medium-risk, and 4% as high-risk. It correctly identified 28% of delayed recoverers as low-risk, 28% as medium-risk, and 44% as high-risk. Medium- to high-risk score within one week of injury was 72% sensitive and 74% specific for delayed recovery.

Conclusions An easily calculable score using 3 questions and 3 physical exam findings within one week of injury identified concussed adolescents who may benefit from early therapeutic intervention.

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