Related Experiment Video
Updated: Nov 15, 2025
Objectively Assessing Sports Concussion Utilizing Visual Evoked Potentials
Published on: April 27, 2021
Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease
Atticus Coscia1, Uwe Stolz, Christopher Barczak
1Department of Emergency Medicine, University of Cincinnati Medical Center, Ohio (Messrs Coscia and Barczak and Drs Stolz and Kreitzer); Jan Medical, Mountain View, California (Ms Wright and Dr Mittermeyer); Ballad Health, Johnson City, Tennessee (Dr Shams); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Dr Epstein); and Division of Neurocritical Care, University of Cincinnati Medical Center, Ohio (Dr Kreitzer).
Objective:
The Sports Concussion Assessment Tool 3 (SCAT3) Symptom Evaluation (SE) is used in the emergency department (ED). This study aimed to examine the effects of psychiatric history on the SCAT3 SE symptom severity score (SSS).
Setting:
Three US EDs.
Participants:
A total of 272 ED patients with suspected concussion.
Design:
Prospective, nonrandomized, nonblinded study. The SCAT3 SE SSS, demographic data, medical information, and self-reported psychiatric history were obtained from patients by clinical research staff when they presented to the ED seeking standard clinical care. Concussion diagnoses were determined following a comprehensive assessment by an ED physician trained in managing concussions and adjudicated by supervising physicians.
Main Measures:
The primary outcome measure was SSS. The association between SSS, self-reported psychiatric disease, and concussion diagnosis was analyzed using multivariable linear regression.
Results:
68.4% of subjects were diagnosed with a concussion. After controlling for age, sex, race, history of previous concussion, and interval from injury to ED presentation, self-reported psychiatric history (adjusted regression coefficient (βa): 16.9; confidence interval [CI]: 10.1, 23.6), and concussion diagnosis (βa: 21.7; CI: 14.2, 29.2) were both independently associated with a significant increase in SSS. Subjects with a history of concussion had a significantly higher SSS (βa: 9.1; CI: 1.8, 16.5). Interval from injury to ED presentation was also associated with a significant increase in SSS (βa: 1.6 per 6-hour increase; CI: 0.4, 2.8).
Conclusion:
Our findings demonstrate that a history of preexisting psychiatric disease, as self-reported by patients with a suspected concussion treated in the ED, is independently associated with significantly higher scores on the SCAT3 SE. This suggests that a history of psychiatric illness may need to be accounted for when the SCAT3 SE is used in the ED for the assessment of concussion.
