Ability of scat3 and childscat3 to discriminate children with concussion from children with upper limb injuries and uninjured children in the emergency department

Abstract

ObjectiveTo evaluate the ability of SCAT3 and ChildSCAT3 to discriminate children with concussion from children with upper limb injuries and uninjured children in the emergency departmentDesignProspective observational study.SettingTertiary children’s hospital emergency department.Participants264 children presenting to ED with concussion (CONC, n=90) and two control groups (i) upper limb injury (ULI, n=90) and (ii) well children (WELL, n=84) with equal sized subgroups in three age bands of 5–8, 9–12, and 13–16 years.Assessment and outcomeChild-SCAT3 was used in 5-12 years, SCAT3 in 13–16 years, administered by trained research assistants. Differences between study groups were analysed using ANOVA. Effect sizes were also assessed.ResultsThe number and severity of child and parent reported symptom scores for SCAT3 and the child-SCAT3 were significantly higher in CONC than either control group (p<0.001). Mean double and tandem stance errors were also significantly higher (p<0.001), and immediate memory and concentration were significantly lower for the CONC group (p<0.01). No group differences were found for orientation and digit backwards.Among SCAT3 symptoms, headache and pressure in head had the highest effect size (0.51 and 0.44 respectively, p<0.001). Among Child SCAT3 symptoms, I have headaches and I feel dizzy had the highest effect size (0.31 and 0.23 respectively, p<0.001). There were no significant differences between ULI and WELL control groups.ConclusionsOverall, SCAT3 and child-SCAT3 can differentiate concussed from non-concussed patients, in particular for number and symptom severity. However, some neuropsychological subtests do not differentiate concussed patients and controls.Competing interestsGAD is an honorary member of the Australian Football League Concussion Working Group, and has attended meetings organised by sporting organisations including the National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. GAD is a member of the International Concussion in Sport group that developed the SCAT3 and ChildSCAT3