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Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Master of Public Health
Department
Physician Assistant; College of Health Sciences
Community & Global Public Health; College of Health Sciences
First Advisor
Amanda Murphy, MMS, PA-C
Second Advisor
Jodi Freeman, MMS, PA-C
Abstract
Introduction: A concussion occurs when rotational and shear forces cause damage to nervous tissue within the brain following a bump or blow to the head. Sport-related concussions are a public health concern due to the complexity of the condition and high prevalence of undiagnosed and/or unreported concussions, as well as a lack of a standardized evaluation tool. This review seeks to answer the following question: In youth athletes who have sustained a concussion, does the SCAT3 more accurately diagnose concussion when used independently or when used in combination with the KD test?
Methods: A literature search was conducted through PubMed, EBSCO, Cochrane Library, OVID, and Google Scholar in November 2018. Fve articles were included based on publication date, full-text availability and sample population. Key words included "(SCAT3 or Sport Concussion Assessment Tool 3) AND King Devick)."
Results: The KD test has adequate sensitivity and specificity for diagnosing concussion, and that the capacity to do so increases significantly when the KD test is used as an adjunct to the SCAT3 in the evaluation of concussion. Only two of the articles investigated the direct relationship between KD and SCAT3; however, each of the five articles concluded that both the KD and the SCAT3 should be recommended for use in a composite test as this significantly increases the capacity for detection.
Discussion: There is a small pool of literature that directly compared the capacity for the SCAT3 to diagnosis concussion alone and in combination with the KD. Those that directly compared the two, demonstrated a statistically significant improvement in discriminatory ability (ROC curve) from 68% to 87% for SCAT3 components alone to 97% to 100% when these tests were combined. Sensitivity and specificity of a composite tool have yet to be determined.
Conclusion: There is no standardized assessment for the sideline evaluation of concussions. The SCAT3 is a widely used consensus-driven tool but it fails to detect changes in saccades, which may contribute to misdiagnosed and mismanaged concussions. Recommendations can be made for a composite test that includes the SCAT3 and the KD test. Further research is warranted to determine the sensitivity, specificity and discriminatory ability.
Recommended Citation
Gregoire, Nicole, "Is Vision Testing the Key to Accurate Diagnosis of Concussion?" (2020). Capstone Showcase. 45.
https://scholarworks.arcadia.edu/showcase/2020/pa/45
Is Vision Testing the Key to Accurate Diagnosis of Concussion?
Introduction: A concussion occurs when rotational and shear forces cause damage to nervous tissue within the brain following a bump or blow to the head. Sport-related concussions are a public health concern due to the complexity of the condition and high prevalence of undiagnosed and/or unreported concussions, as well as a lack of a standardized evaluation tool. This review seeks to answer the following question: In youth athletes who have sustained a concussion, does the SCAT3 more accurately diagnose concussion when used independently or when used in combination with the KD test?
Methods: A literature search was conducted through PubMed, EBSCO, Cochrane Library, OVID, and Google Scholar in November 2018. Fve articles were included based on publication date, full-text availability and sample population. Key words included "(SCAT3 or Sport Concussion Assessment Tool 3) AND King Devick)."
Results: The KD test has adequate sensitivity and specificity for diagnosing concussion, and that the capacity to do so increases significantly when the KD test is used as an adjunct to the SCAT3 in the evaluation of concussion. Only two of the articles investigated the direct relationship between KD and SCAT3; however, each of the five articles concluded that both the KD and the SCAT3 should be recommended for use in a composite test as this significantly increases the capacity for detection.
Discussion: There is a small pool of literature that directly compared the capacity for the SCAT3 to diagnosis concussion alone and in combination with the KD. Those that directly compared the two, demonstrated a statistically significant improvement in discriminatory ability (ROC curve) from 68% to 87% for SCAT3 components alone to 97% to 100% when these tests were combined. Sensitivity and specificity of a composite tool have yet to be determined.
Conclusion: There is no standardized assessment for the sideline evaluation of concussions. The SCAT3 is a widely used consensus-driven tool but it fails to detect changes in saccades, which may contribute to misdiagnosed and mismanaged concussions. Recommendations can be made for a composite test that includes the SCAT3 and the KD test. Further research is warranted to determine the sensitivity, specificity and discriminatory ability.