Objective Develop a clinically pragmatic dual-task balance test to identify balance deficits in acutely concussed adolescents more accurately than the current standard mBESS.

Design Observational cohort study.

Setting Pediatric emergency department.

Participants Adolescents aged 10–17 years with acute (<48 hours) concussion.

Outcome Measures Primary outcome was difference in clinical performance between single-task and dual-task tests (dual-task cost). Single-tasks: balance (mBESS errors); cognitive function (Oral Trail-Making Test-B accuracy); and visual-vestibular function (symptom change pre-post gaze stabilization test). Dual-tasks: (1) balance + cognitive function; (2) balance + visual-vestibular function. We performed preliminary linear regression and AIC model selection to determine which dual-task cost model(s) best correlate(s) with centre-of-pressure changes on a force plate (95% ellipse) compared with mBESS.

Main Results 55 adolescents (median[IQR] age=12.8[11.7,15.3] years; 60% male; median[IQR] time from injury=2.8[2.0,6.8] hours) were included in this analysis. Correlation coefficients between dual-task costs and centre-of-pressure changes were higher for tandem stance with visual-vestibular function (r=0.77) than mBESS (r=0.62). The best-fit model (∆AIC=0) was the difference between balance errors during tandem stance with visual-vestibular function and balance errors during tandem stance alone (dual-task cost). mBESS poorly correlated with centre-of-pressure changes (∆AIC=17.1).

Conclusions Return to clinically normal balance is a prerequisite for return-to-sport clearance. Preliminary results suggest that the difference between balance errors during tandem stance with visual-vestibular function and balance errors during tandem stance alone better identifies centre-of-pressure changes than the current standard mBESS. Further research should determine whether this dual-task balance measure discriminates adolescents with and without concussion across the recovery continuum.