Background
The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5 and 12 years of age for a suspected concussion. However, limited empirical ...evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion.
Methods
Our participants included 34 concussed (21 boys, 13 girls; age = 12.8 ± 0.86 years) and 44 non-concussed (31 boys, 13 girls; age = 12.4 ± 0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes (
r
=
Z
n
) were calculated to assess the magnitude of difference for each comparison. The diagnostic properties (sensitivity, specificity, diagnostic accuracy, predictive values, likelihood ratios, and diagnostic odds ratio) of each Child SCAT5 score were also calculated.
Results
Concussed children endorsed more symptoms (
p
< 0.001,
r
=0.45), higher symptom severity (
p
< 0.001,
r
=0.44), and had higher double leg (
p
= 0.046,
r
=0.23), single leg (
p
= 0.035,
r
=0.24), and total scores (
p
= 0.022,
r
=0.26) for the mBESS than the non-concussed children. No significant differences were observed for the SAC-C scores (
p’s
≥ 0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC = 0.76–0.77), negative predictive values (NPV = 0.84–0.88), and negative likelihood ratios (-LR = 0.22–0.31) of the Child SCAT5 scores.
Conclusions
Clinicians should prioritize interpretation of the symptom evaluation form of the Child SCAT5 as it was the most effective component for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.
Background:
Girls’ high school lacrosse players have higher rates of head and facial injuries than boys. Research indicates that these injuries are caused by stick, player, and ball contacts. Yet, no ...studies have characterized head impacts in girls’ high school lacrosse.
Purpose:
To characterize girls’ high school lacrosse game-related impacts by frequency, magnitude, mechanism, player position, and game situation.
Study Design:
Descriptive epidemiology study.
Methods:
Thirty-five female participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered during 28 games in the 2014 and 2015 lacrosse seasons. Participants wore impact sensors affixed to the right mastoid process before each game. All game-related impacts recorded by the sensors were verified using game video. Data were summarized for all verified impacts in terms of frequency, peak linear acceleration (PLA), and peak rotational acceleration (PRA). Descriptive statistics and impact rates were calculated.
Results:
Fifty-eight verified game-related impacts ≥20g were recorded (median PLA, 33.8g; median PRA, 6151.1 rad/s2) during 467 player-games. The impact rate for all game-related verified impacts was 0.12 per athlete-exposure (AE) (95% CI, 0.09-0.16), equivalent to 2.1 impacts per team game, indicating that each athlete suffered fewer than 2 head impacts per season ≥20g. Of these impacts, 28 (48.3%) were confirmed to directly strike the head, corresponding with an impact rate of 0.05 per AE (95% CI, 0.00-0.10). Overall, midfielders (n = 28, 48.3%) sustained the most impacts, followed by defenders (n = 12, 20.7%), attackers (n = 11, 19.0%), and goalies (n = 7, 12.1%). Goalies demonstrated the highest median PLA and PRA (38.8g and 8535.0 rad/s2, respectively). The most common impact mechanisms were contact with a stick (n = 25, 43.1%) and a player (n = 17, 29.3%), followed by the ball (n = 7, 12.1%) and the ground (n = 7, 12.1%). One hundred percent of ball impacts occurred to goalies. Most impacts occurred to field players within the attack area of the field (n = 32, 55.2%) or the midfield (n = 18, 31.0%). Most (95%) impacts did not result in a penalty.
Conclusion:
The incidence of verified head impacts in girls’ high school lacrosse was quite low. Ball to head impacts were associated with the highest impact magnitudes. While stick and body contacts are illegal in girls’ high school lacrosse, rarely did such impacts to the head result in a penalty. The verification of impact mechanisms using video review is critical to collect impact sensor data.
Girls' lacrosse participation and head injury rates have increased
. In response, optional headgear was implemented following the recently developed ASTM International (ASTM) lacrosse headgear ...performance standards. It remains unknown how lacrosse headgear responds to blunt impacts after use. Our purpose was to compare the peak linear acceleration (PLA) between girls' lacrosse headgear conditions (pristine and used) during blunt impacts. Pristine headgear (n=10) were tested in their original condition and used headgear (n=10) were worn for an entire competitive season. A Cadex Monorail Impactor impacted all headgear following ASTM standards (F1446-15b, F2220-15, and F3137-15) in the required testing locations. A 2 x 7 repeated measures ANOVA compared PLA among headgear conditions and impact locations with a simple effects analysis planned comparison. There was no difference between headgear conditions for PLA (Pristine: 47.12 ± 13.92g; Used: 46.62 ± 14.84g; F = 2.11,
> 0.05). A main effect for impact location (F = 983.52,
< 0.01), and an interaction effect of condition and impact location (F = 12.79,
< 0.01) were observed. All headgear, regardless of condition, met the ASTM performance standard. This suggests that headgear performance may not degrade subsequent to a single season of high school girl's lacrosse.
Abstract
Purpose
Virginia state law requires athletes with suspected concussions to be evaluated and receive written clearance from an appropriately licensed healthcare provider (HCP) before ...returning to play. This HCP is defined as a physician, physician assistant, athletic trainer (AT), neuropsychologist, physical therapist, or nurse practitioner. However, little is known regarding whether access to HCPs in Virginia differs by locality. We explored stakeholders’ access to HCPs.
Methods
An electronic survey assessed school and community stakeholders’ perceptions of accessibility to HCPs. Results were stratified by locale (National Center for Education Statistics locality classifications). Participants were a convenience sample recruited through collaboration with state professional organizations.
Results
400 respondents (city n=61, 15%, suburban n=142, 36%, town n=67, 17%, and rural n=130, 33%) completed the survey. Overall, three out of four (77%) reported having access to community HCPs, though rates were substantially higher among those from cities (92% city, 80% suburban, 80% town). However, only 66% of respondents from rural areas reported access to an HCP. Additionally, when asked about access to an AT, 45% of stakeholders responded that they had no access to an AT. Most respondents with no AT access were from suburban (34%) or rural (39%) locales, and 43% reported traveling >30 minutes to access an HCP.
Conclusions
Our findings indicate access disparities such that rural Virginians report less access to licensed HCPs for concussion clearance. In communities without an AT, it may require considerable travel to reach an HCP. Further investigation is needed into strategies that promote equal access to HCPs.
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