Discriminating Young Children with Concussion in an Outpatient Specialty Clinic from Healthy Controls Using the Child Sports Concussion Assessment Tool-5

Abstract

To evaluate the clinical utility of the Sports Concussion Assessment Tool-5 Child (Child SCAT5) in an outpatient specialty clinic sample of children aged 5-9 years. Ninety-six children within 30days of a concussion (mean = 8.90±5.78days) and 43 age- and sex-matched healthy controls completed the Child SCAT5, including balance items, cognitive screening, parent and child symptom severity reports, as well as each individual parent- and child-rated symptom severity (0-3). A series of receiver operating characteristic curves with area under the curve (AUC) analysis were performed to evaluate the clinical utility of the Child SCAT5 components to discriminate concussion. The AUC values were nondiscriminate for cognitive screening (0.32) and poor for balance (0.61) items. The AUC values were acceptable for parent-reported symptoms worsening after physical activity (0.73) and mental activity (0.72). The AUCs for symptom severity items were excellent for parent (0.89) and child-reported (0.81) headaches, and were acceptable for parent-reported tired a lot (0.75) and both parent- (0.72) and child-reported (0.72) tired easily. With the exception of parent- and child-reported symptoms, the Child SCAT5 provides limited clinical utility for evaluating concussion in children aged 5-9years seen at an outpatient concussion specialty clinic. The cognitive screening and balance testing items were not useful in discriminating concussion. Parent- and child-reported headache were the only Child SCAT5 items with excellent ability to differentiate concussion from controls in the age group.