SCAT5 Sex Differences: Normative Data, Clinical Thresholds, and Relevance for Identification of Concussion

Area of Science:

• Sports Medicine
• Neuroscience
• Clinical Assessment

Background:

• The Sport Concussion Assessment Tool-5 (SCAT5) is widely used for concussion evaluation.
• Understanding sex differences in cognitive performance and symptom reporting is crucial for accurate concussion diagnosis.

Purpose of the Study:

• To evaluate sex differences in SCAT5 Standardized Assessment of Concussion (SAC) performance and baseline symptom reporting.
• To establish clinically relevant cut points for low SAC performance.
• To assess the diagnostic utility of sex-adjusted SCAT5 SAC for identifying concussions in collegiate athletes.

Main Methods:

• Administered SCAT5 to 671 uninjured collegiate athletes, with follow-up testing for 264.
• Tested 54 athletes removed from play due to suspected concussion.
• Evaluated sex differences in cognitive performance and symptom reporting, establishing sex-specific cut points.
• Used chi-square and logistic regression to determine SAC performance as a predictor of concussion status.

Main Results:

• Female athletes outperformed male athletes on the SCAT5 SAC.
• Sex-corrected normative data enhanced the SAC's ability to identify suspected concussions.
• Sex-corrected SAC change from baseline (RCI) improved predictive value in logistic regression models.

Conclusions:

• Results support using sex-specific normative data for the SCAT5 SAC, particularly for identifying low performance without baseline comparison.
• Reliable change from a pre-injury baseline may offer higher diagnostic utility for concussion identification.