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 .
Assessment of mild traumatic brain injury with the King-Devick Test® in an emergency department sample
Abstract Objective : The King-Devick Test ® ( K-D ) is a brief measure of cognitive processing speed and rapid gaze shifting that appears sensitive to the effects of sport-related concussion . This study evaluated its diagnostic and incremental validity in civilian patients with mild traumatic brain injury ( MTBI ) . Methods : Participants with MTBI ( n = 26 ) and controls with non-head injuries ( n = 33 ) were prospect ively recruited from an Emergency Department ( ED ) . They underwent a clinical evaluation including the  K-D test and the Sport Concussion Assessment Tool 2 ( SCAT2 ) . Magnetic resonance imaging ( MRI ) was conducted within 10 days post-injury . Results : The patients with MTBI differed from those without MTBI on components of the SCAT2 , including the Symptom Scale ( Cohen ’s d = 1.02–1.15 , p < 0.001 ) and St and ardized Assessment of Concussion ( d = 0.81 , p = 0.004 ) , but not the K-D test ( d = 0.40 , p = 0.148 ) . In a logistic regression analysis , the K-D Test did not contribute over and above these two measures in predicting group membership ( MTBI vs. control ) , p = 0.191 . Low K-D Test scores in the MTBI group ( < 1 SD below controls ) were not associated with poor SCAT2 performance , loss of consciousness or traumatic abnormalities on MRI , suggesting these cases may have been false positives . Conclusions : The present findings do not support the K-D Test for the assessment of civilian MTBI in an ED setting
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 .