What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review

Abstract

background Sideline detection is the first and most significant step in recognising a potential concussion and removing an athlete from harm. This systematic review aims to evaluate the critical elements aiding sideline recognition of potential concussions including screening tools, technologies and integrated assessment protocols. Data sources Bibliographic databases, grey literature repositories and relevant websites were searched from 1 January 2000 to 30 September 2016. A total of 3562 articles were identified. study selection Original research studies evaluating a sideline tool, technology or protocol for sports-related concussion were eligible, of which 27 studies were included. Data extraction A standardised form was used to record information. The QUADAS-2 and NewcastleOttawa tools were used to rate risk of bias. Strength of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation Working Group system. Data synthesis Studies assessing symptoms, the King-Devick test and multimodal assessments reported high sensitivity and specificity. Evaluations of balance and cognitive tests described lower sensitivity but higher specificity. However, these studies were at high risk of bias and the overall strength of evidence examining sideline screening tools was very low. A strong body of evidence demonstrated that head impact sensors did not provide useful sideline concussion information. Lowstrength evidence suggested a multimodal, multitimebased concussion evaluation process incorporating video review was important in the recognition of significant head impact events and delayed onset concussion.

American Medical Society for Sports Medicine position statement on concussion in sport

“…A healthcare professional familiar with the athlete is best suited to detect subtle changes in the athlete’s personality or test performance that may suggest concussion. If a concussion is suspected but not diagnosed, removal from play and serial evaluations are recommended 38. Concussion assessment should be performed in a distraction-free environment with adequate time for examination and administration of concussion tests.…”

Treatments and rehabilitation in the acute and chronic state of traumatic brain injury

“…In the SCAT‐5 these tools are named the Maddocks questions. In general, cognitive tests describe lower sensitivity, but good specificity when used in SRC management .…”

Resilient or reckless? Robust debate on risk and reward in sport

“…The Berlin Concussion Consensus meeting highlighted the potential for sideline video analysis to help identify concussions 3. Ross Tucker (www.sportsscience.com and @ScienceofSport) takes this further, using video analysis to analyse head injury events in Rugby Union in two linked pieces ( see , see ) of original research.…”