The sensitivity and specificity of commonly implemented sideline assessment tools are generally good to very good , especially for symptom scores and cognitive evaluations performed within 48 hours of injury , and they are improved when a baseline evaluation is available for comparison .
CONTEXT The sideline assessment of concussion is challenging , given its variable presentations , the limited sensitivity and specificity of sideline assessment tools , and how the presentation of the injury evolves over time .
In addition , the diagnostic process , as well as the tools used to assess and manage concussion , continue to progress as research and what we know about concussion advance .
This paper focuses on the initial assessment on the sideline by review ing the concussion-evaluation literature , drawing from clinical experience to emphasize a st and ardized approach , and underscoring the importance of both familiarity with the athlete and clinical judgment .
OBJECTIVE To review the evidence regarding the clinical assessment of sport-related concussion on the sideline .
Additional considerations included making same-day return-to-play decisions , the sensitivity and specificity of sideline testing , and the importance of ongoing assessment and follow-up of injured athletes .
CONCLUSIONS The sideline assessment of sport-related concussion is challenging given the elusiveness and variability of presentation , reliance on athlete-reported symptoms , and the varying specificity and sensitivity values of sideline assessment tools .
In addition , the recognition of injury and assessment often occur in a time-pressured environment , requiring rapid disposition and decision making .
Interrater reliability of Glasgow Coma Scale scores in the emergency department.
STUDY OBJECTIVE Emergency physicians often use the Glasgow Coma Scale ( GCS ) to help guide decisions in patient care , yet the reliability of the GCS has never been tested in a typical broad sample of emergency department ( ED ) patients . We determined the interrater reliability of the GCS between emergency physicians when adult patients with altered levels of consciousness are assessed . METHODS In this prospect i ve observational study at a university Level I trauma center , we enrolled a convenience sample of ED patients older than 17 years who presented with an altered level of consciousness . Two residency-trained attending emergency physicians independently assessed and recorded the GCS score and its components ( eye , verbal , and motor ) in blinded fashion within a 5-minute period . Data were analyzed for interrater reliability by using st and ard ordinal calculations . We also created scatter plots and Bl and -Altman plots for each GCS component and for the GCS score . RESULTS One hundred thirty-one patients were screened and enrolled in the study , with 15 excluded because of protocol violations . Of the 116 remaining patients , the agreement percentage for exact total GCS was 32 % ( tau-b=0.739 ; Spearman rho=0.864 ; Spearman rho2=75 % ) . Agreement percentage for GCS components were eye 74 % ( tau-b=0.715 ; Spearman rho=0.757 ; Spearman rho2=57 % ) , verbal 55 % ( tau-b=0.587 ; Spearman rho=0.665 ; Spearman rho2=44 % ) , and motor 72 % ( tau-b=0.742 ; Spearman rho=0.808 ; Spearman rho2=65 % ) . Our Spearman 's analyses found that only approximately half ( 44 % to 65 % ) of the observed variance could be explained by the relationship between the paired component measures . For GCS components , only 55 % to 74 % of paired measures were identical , and 6 % to 17 % of them were 2 or more points apart . CONCLUSION We found only moderate degrees of interrater agreement for the GCS and its components
The sensitivity and specificity of commonly implemented sideline assessment tools are generally good to very good , especially for symptom scores and cognitive evaluations performed within 48 hours of injury , and they are improved when a baseline evaluation is available for comparison .
CONTEXT The sideline assessment of concussion is challenging , given its variable presentations , the limited sensitivity and specificity of sideline assessment tools , and how the presentation of the injury evolves over time .
In addition , the diagnostic process , as well as the tools used to assess and manage concussion , continue to progress as research and what we know about concussion advance .
This paper focuses on the initial assessment on the sideline by review ing the concussion-evaluation literature , drawing from clinical experience to emphasize a st and ardized approach , and underscoring the importance of both familiarity with the athlete and clinical judgment .
OBJECTIVE To review the evidence regarding the clinical assessment of sport-related concussion on the sideline .
Additional considerations included making same-day return-to-play decisions , the sensitivity and specificity of sideline testing , and the importance of ongoing assessment and follow-up of injured athletes .
CONCLUSIONS The sideline assessment of sport-related concussion is challenging given the elusiveness and variability of presentation , reliance on athlete-reported symptoms , and the varying specificity and sensitivity values of sideline assessment tools .
In addition , the recognition of injury and assessment often occur in a time-pressured environment , requiring rapid disposition and decision making .