Determining Sport Concussion Assessment Tool fifth Edition (SCAT5) reliable change in male professional hockey players

Abstract

ObjectivesThe purpose of this paper is to provide reliable change metrics and assess the test–retest psychometrics of the Sport Concussion Assessment Tool fifth Edition (SCAT5) in a multilingual sample of professional ice hockey players.MethodsThe SCAT5 was administered to National Hockey League and American Hockey League male professional ice hockey players as part of the 2018 and 2019 season medical evaluations. We extracted data from an existing clinical database of players who were administered two consecutive baseline evaluations and had no intervening concussions to assess psychometric properties (eg, test–retest reliability) and develop reliable change metrics.ResultsOverall, 1007 players met inclusion criteria. Players were reassessed on average 344.52 (±62.52) days following their first baseline. Test–retest reliability ranged from r=0.3 to r=0.5. Reliable change metrics for Immediate Memory varied considerably dependent on form order. Significant differences were found between English versus non-English language preference on Immediate Memory and Concentration but not Delayed Memory or the modified Balance Error Scoring System (mBESS). Reliable change indices at the 90% CI were: Symptom Severity (5), Total Symptoms (3), Immediate Memory (3-8), Concentration (2), mBESS (5) and Delayed Memory (2-4).ConclusionsOur findings highlight the importance of considering form differences and language preference when determining reliable change from baseline on the SCAT5 in male professional hockey players. The relatively modest test–retest reliability of the measures leaves room for improved psychometric properties and increased sensitivity to concussion in future iterations of the SCAT.

Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review

“…Five studies published test–retest reliability for SCAT5 subtests. Test–retest reliability for component and total SAC scores was poor, ranging between 0.22 and 0.52 61 62 71–73. Base rates enable the quantitative interpretation of multiple tests simultaneously, reducing the risk of false-positive results.…”

“…Base rates enable the quantitative interpretation of multiple tests simultaneously, reducing the risk of false-positive results. One study examined base rates of decline on the SCAT5 using reliable change indices 71. Findings showed that decline at the 0.80 CI (32.3% of sample) or 0.90 CI (20.7% of sample) level on only one of three considered SCAT5 subtests was relatively common in a non-concussed sample 71.…”

“…One study examined base rates of decline on the SCAT5 using reliable change indices 71. Findings showed that decline at the 0.80 CI (32.3% of sample) or 0.90 CI (20.7% of sample) level on only one of three considered SCAT5 subtests was relatively common in a non-concussed sample 71. In contrast, decline on one SCAT5 test at the 0.95 CI (12.9% of sample) or two or more tests at the 0.80 CI (8.3% of sample) is sufficiently rare to warrant clinical concern supporting possible concussion diagnosis.…”

“…Quality normative data, however, may not be available for a broad range of athletes, and particularly those with psychiatric/neurologic history, learning disabilities (LD)/ attention defici hyperactivity disorder (ADHD), giftedness, cultural/linguistic differences, or para athletes 252 253. In these situations, neuropsychological testing with regression-based models incorporating both baseline testing and demographic data may represent the most robust and reliable diagnostic approach 71 75. In sum, widespread baseline testing may be useful when resources (eg, financial, personnel, time) permit, such as at the professional or elite level, but the evidence does not support across-the-board mandatory use at other levels of sport, such as at the child and adolescent level.…”

Chronic Traumatic Encephalopathy in Soccer Players: Review of 14 Cases

“…97,[102][103][104] If the symptoms of the soccer player combined with video-analysis suggest a concussion, there are specific diagnostic tools to substantiate the diagnosis: the Standardized Assessment of Concussion can be used directly, 103 the Sport Concussion Assessment Tool (SCAT5) is applied off-field. 105…”