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Related Experiment Video

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Using sideline concussion tests in the emergency department.

Adam J Kruse1, Andrew S Nugent2, Andrew R Peterson3

  • 1Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.

Open Access Emergency Medicine : OAEM
|October 6, 2018
PubMed
Summary

The Concussion Symptom Severity Score (CSSS) is a sensitive and well-tolerated test for detecting traumatic brain injury (TBI) in emergency departments. The modified Balance Error Scoring System (mBESS) is not recommended for TBI assessment in this setting.

Keywords:
Sport Concussion Assessment Toolbalanceconcussion symptom severity scoreemergency roommodified balance error scoring systemtraumatic brain injury

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Sports Medicine

Background:

  • Traumatic brain injury (TBI) is a leading cause of death and disability.
  • Emergency departments (ED) manage many TBI patients.
  • Current methods lack evidence for grading TBI with normal neuroimaging.

Purpose of the Study:

  • Evaluate the validity of sideline concussion tests in the ED.
  • Assess the Concussion Symptom Severity Score (CSSS) and modified Balance Error Scoring System (mBESS) for TBI detection.
  • Determine test utility in non-sport-related TBI and moderate/severe TBI.

Main Methods:

  • 148 TBI patients and 53 controls were enrolled.
  • CSSS and mBESS were administered within 72 hours of TBI.
  • Clinical outcomes were prospectively followed.

Main Results:

  • CSSS mean scores differed significantly between TBI (32.25) and controls (2.70) (P < 0.001).
  • mBESS scores were similar between TBI (7.43) and controls (7.20) (P = 0.82).
  • CSSS > 5.17 showed 93.43% sensitivity and 69.84% specificity for TBI.

Conclusions:

  • mBESS is poorly tolerated and not sensitive to TBI in the ED.
  • CSSS is sensitive to TBI and well-tolerated in the ED setting.
  • CSSS shows promise for TBI detection when neuroimaging is normal.