Comparison of Baseline Concussion Tests in Youth and Collegiate Football Players

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As proper medical care for sports concussions is increasingly emphasized, administering baseline testing can be a valuable component of a comprehensive concussion management strategy, especially for athletes who participate in contact/collision sports. PURPOSE: To compare baseline measurements of Youth (middle school) and Collegiate (NCAA Division II) American football players on three tests used for the evaluation of sports concussion. METHODS: Sixty-two healthy football players (31 Youth: 13.2 ± 0.5 yr; 31 Collegiate: 20.3 ± 1.6 yr) performed baseline concussion testing before their respective seasons. Testing included balance (BAL; twenty second, bipedal standing on a Wii Balance Board for four conditions; eyes open [O], eyes open + cognitive task [OC], eyes closed [C], eyes closed + cognitive task [CC]), oculomotor function (KD; King-Devick) and multiple object tracking (MOT; NeuroTracker). Postural sway values (95% Ellipse Area [EA]) for each BAL condition, KD total time and MOT speed thresholds (Core 1, 2 & 3) for each group were compared. RESULTS: EA was significantly lower in three (O, C, CC) of the four BAL tests in Collegiate vs. Youth players (O: 0.83 ± 0.70 vs. 1.48 ± 1.08 cm2, P = 0.006; C: 1.20 ± 1.00 vs. 2.20 ± 1.16 cm2, P < 0.001; CC: 1.29 ± 1.53 vs. 6.18 ± 13.20 cm2, P = 0.045). EA was not different between Collegiate and Youth players in the OC condition (1.63 ± 3.04 vs. 5.85 ± 15.96 cm2, P = 0.153). KD total time was significantly faster in Collegiate vs. Youth players (38.44 ± 6.18 vs. 51.47 ± 10.04 s, P < 0.001). Collegiate players had faster speed thresholds on two (Core 1 & 2) of the three MOT tests (Core 1: 5.55 ± 0.84 vs. 4.90 ± 1.27 m∙s-1, P = 0.020; Core 2: 3.29 ± 0.82 vs. 2.89 ± 0.75 m∙s-1, P = 0.047). Speed threshold was not different between the Collegiate and Youth players in Core 3 of MOT (2.21 ± 0.45 vs. 2.00 ± 0.63 m∙s-1, P = 0.143). CONCLUSION: Collegiate players had better baseline scores on a majority of the clinical concussion tests. These findings highlight the importance of recurrent baseline testing and/or use of age-specific normative values in concussion evaluation. Moreover, youth players had greater variability in their test results, thus medical personnel should exercise caution when relying solely on normative scores to evaluate the neurologic function of youth suspected of having a concussion.