Scoring System For Use Research Articles

Technical note: The development of a reliable 5-point gait scoring system for use in dairy goats

Numerical rating scales are frequently used in gait scoring systems as indicators of lameness in dairy animals. The gait scoring systems commonly used in dairy goats are based on 4-point scales that focus on detecting and judging the severity of a definite limp. An uneven gait, such as a shortened stride or not "tracking up," is arguably the precursor to the development of a limp; thus, identifying such changes in gait could provide opportunity for early treatment. The objectives of this study were (1) to develop a 5-point gait scoring system that included an "uneven gait" category and compare the distribution of gait scores generated using this system to scores generated using a 4-point system, and (2) to determine whether this system could be reliably used. Forty-eight Saanen cross 2- and 3-yr-old lactating does were enrolled from a commercial dairy goat farm. Two observers carried out weekly live gait scoring sessions for 7 wk using the developed 5-point scoring system. The first 2 wk were used as training sessions (training sessions 1-2), with the subsequent 5 wk completed as gait assessments (assessments 1-5). In addition to training session 1 being lived scored, the goats were also video-recorded. This allowed observer 1 to re-score the session 4 times: twice using the developed 5-point system and twice using the previously used 4-point system. Comparisons of score distributions could then be made. Using the 4-point system, 81% of the goats were assigned score 1 (normal gait). Using the 5-point system, only 36% of the goats were assigned score 1 (normal gait), with 50% assigned score 2 (uneven gait). High levels of intra-observer reliability were achieved by observer 1 using both gait scoring systems [weighted kappa (κw) = 1.00: 4-point, κw = 0.96: 5-point]. At training session 1 (wk 1), inter-observer reliability was only moderate (κw = 0.54), but this was improved during the subsequent training session 2 (κw = 0.89). Inter-observer reliability was high among assessments 1 to 5 (κw = 0.90-1.00). During the training sessions, sensitivity for gait scores 1 and 2 was 77 and 65% (training session 1) and 89 and 94% (training session 2), respectively. Sensitivity was high among assessments 1 to 5 (score 1: 83-100%, score 2: 97-100%). This highlights the likely reason why existing gait scoring systems for dairy goats do not include an "uneven gait" category, as distinguishing it from a normal gait was challenging without training. In conclusion, with training, a 5-point gait scoring system could be reliably used. The 5-point system was found to be more sensitive than the 4-point system, allowing for a potential precursor to lameness to be identified. Further work is needed to determine whether the score can be reliably used in an on-farm setting.

Measuring Change In Small Intestinal Histology In Patients With Celiac Disease.

Small intestinal histologic abnormalities in celiac disease include atrophy of the intestinal villi, hypertrophy of the crypts and lymphocytic infiltration of intraepithelial spaces and lamina propria. These findings are central to diagnosis and their severity and change over time are valuable to monitor disease course and response to therapy. Subjective methods to grade celiac disease histological severity include the Marsh-Oberhuber and Corazza-Villanacci systems. Quantitative histology uses villus height (Vh), crypt depth (Cd), and intra-epithelial lymphocyte count (per 100 enterocytes) to provide objective measures of histologic changes including Vh:Cd ratio. Here we examine the available literature regarding these methodologies and support the use of quantitative histology as the preferred method for accurately and reproducibly demonstrating change of relevant histologic end points over time. We also propose a Quantitative-Mucosal Algorithmic Rules for Scoring Histology (Q-MARSH) system to partially align quantitative histology results with the traditional Marsh, Marsh-Oberhuber, and Corazza-Villanacci systems. Q-MARSH can provide a standardized, objective, and quantitative histology scoring system for use as a clinical or research application.

Proposal for a New Histological Scoring System for Cartilage Repair

OBJECTIVE:This study aimed to develop a new histological scoring system for use in a partial-thickness cartilage repair animal model. Although previous papers have investigated the regeneration of articular cartilage, the good results achieved in small animals have not been replicated in large animal models or humans, possibly because of the frequent use of models with perforation of the subchondral bone plates. Partial-thickness lesions spare the subchondral bone, and this pattern is the most frequent in humans; therefore, new therapies should be tested using this model. However, no specific histological score exists to evaluate partial-thickness model results.METHODS:Histological sections from 30 ovine knees were reviewed to develop a new scoring system. The sections were subjected to H&E, Safranin O, and Masson's trichrome staining.RESULTS:This paper describes a new scoring tool that is divided into sections in detail: repair of tissue inside the lesion, cartilage around the lesion and degenerative changes at the base of the lesion. Scores range from 0 to 21; a higher score indicates better cartilage repair.DISCUSSION:Unlike existing tools, this new scale does not assign points for the positioning of a tidemark; we propose evaluation of the degenerative changes to the subchondral bone and calcified cartilage layer. It is necessary to remove the whole joint to access and study the evolution of the lesion as well as the surrounding tissue.CONCLUSION:This article emphasizes the importance of a partial-thickness animal model of cartilage repair and presents a new histological scoring system.

An easy-to-use baseline scoring system to predict response to peginterferon alfa-2a in patients with chronic hepatitis B in resource-limited settings

Approximately one-third of patients have durable responses after finite (48-week) treatment with peginterferon alfa-2a. The ability to identify patients likely to respond would be particularly useful in resource-limited settings. Data from 1,363 peginterferon alfa-2a recipients (955 hepatitis B 'e' antigen [HBeAg]-positive and 408 -negative) in six studies were analysed. Baseline scoring systems were developed using generalized additive models and multiple logistic regression analysis to predict virological response (VR; HBV DNA <2,000 IU/ml), alone or combined with alanine aminotransferase (ALT) normalization (CR) at 24 weeks post-treatment. Based on the final models, points were assigned for age ≥45 (0) or <45 years (1); male (0) or female (1); hepatitis B surface antigen (HBsAg) >25,000 (0), >7,500-≤25,000 (1), >1,250-≤7,500 (2) or ≤1,250 IU/ml (4); HBV DNA >5 (0) or ≤5 log10 IU/ml (2) and ALT ratio >1-7 (0) or either ≤1 or >7 (1). Higher total scores (range 0-9) indicate higher likelihood of response. VR and CR rates were 28.5% (388/1,363) and 24.4% (332/1,363), respectively, and increased with increasing score: score 0-1 (n=257), VR 14.8%, CR 12.8%; score 2-3 (n=711), VR 23.1%, CR 20.1%; score ≥4 (n=395), VR 47.1%, CR 39.5%. An easy-to-use baseline scoring system for use in settings where HBeAg status and HBV genotypes are unavailable would allow clinicians to identify patients with a low or high chance of achieving a durable post-treatment response to peginterferon alfa-2a. The tool can be used to inform treatment decisions in resource-limited settings.

Novel early structural MRI scoring system for use at 29–35 weeks postmenstrual age in infants born &lt;31 weeks gestation

Novel early structural MRI scoring system for use at 29–35 weeks postmenstrual age in infants born &lt;31 weeks gestation

The ultrasound 7 score in the assessment of synovitis in rheumatoid arthritis: correlation with clinical disease activity indices

ObjectiveThe aim of the paper was to assess value of ultrasound 7 score (US7) in the detection of synovitis in rheumatoid arthritis (RA) and its correlation with clinical disease activity indices.Patients and methodsA total of 50 patients with RA were included. Disease activity was assessed by clinical disease activity indices. Erythrocyte sedimentation rate was measured, and simple erosion narrowing score was used for radiography scoring. Musculoskeletal US7 score was done which combines each joint score for synovial proliferation (gray-scale ultrasound ‘GSUS7’) and vascularization (power Doppler ultrasound ‘PDUS7’).ResultsDetailed joint region examination by US7 score was done. Dorsomedian aspect of wrist (94%), palmar aspect of metacarpophalangeal joint (MCP) II (96%), and palmar aspect of phalangeal interproximal (PIP) II and III (92%) were the most affected joint regions with synovitis by GSUS. However, for detection of synovitis by PDUS, dorsomedian aspect of wrist and dorsal aspect of MCP, PIP II, and PIP III were involved. Erosions were found most in radial aspect of MCP II (70%), lateral aspect of metatarsophalangeal joint V (72%), and dorsal aspect of PIP II (54%) and PIP III (44%). All clinical disease activity indices were correlated with GSUS7 and PDUS7 synovitis.ConclusionUS7 was simple and practical sum scoring system for use in the detection of synovitis in patients with RA. The correlations between the clinical disease activity indices, erythrocyte sedimentation rate, duration of illness, radiographic score, and components of the US7 score reflects the value of US7 score in assessment of disease activity and severity.

Whole-body Magnetic Resonance Imaging in Inflammatory Arthritis: Systematic Literature Review and First Steps Toward Standardization and an OMERACT Scoring System.

Whole-body magnetic resonance imaging (WB-MRI) is a relatively new technique that can enable assessment of the overall inflammatory status of people with arthritis, but standards for image acquisition, definitions of key pathologies, and a quantification system are required. Our aim was to perform a systematic literature review (SLR) and to develop consensus definitions of key pathologies, anatomical locations for assessment, a set of MRI sequences and imaging planes for the different body regions, and a preliminary scoring system for WB-MRI in inflammatory arthritis. An SLR was initially performed, searching for WB-MRI studies in arthritis, osteoarthritis, spondyloarthritis, or enthesitis. These results were presented to a meeting of the MRI in Arthritis Working Group together with an MR image review. Following this, preliminary standards for WB-MRI in inflammatory arthritides were developed with further iteration at the Working Group meetings at the Outcome Measures in Rheumatology (OMERACT) 2016. The SLR identified 10 relevant original articles (7 cross-sectional and 3 longitudinal, mostly focusing on synovitis and/or enthesitis in spondyloarthritis, 4 with reproducibility data). The Working Group decided on inflammation in peripheral joints and entheses as primary focus areas, and then developed consensus MRI definitions for these pathologies, selected anatomical locations for assessment, agreed on a core set of MRI sequences and imaging planes for the different regions, and proposed a preliminary scoring system. It was decided to test and further develop the system by iterative multireader exercises. These first steps in developing an OMERACT WB-MRI scoring system for use in inflammatory arthritides offer a framework for further testing and refinement.

Role of ultrasound disease activity score in assessing inflammatory disease activity in rheumatoid arthritis patients

Aim of the workTo evaluate role of ultrasound disease activity score (DAS) in assessing joint inflammation in rheumatoid arthritis (RA), and its correlation with disease parameters. Patients and methodsFifty RA were included. All patients were assessed for DAS-28, health assessment questionnaire disability index (HAQ-DI) and X-ray simple erosion narrowing score (SENS). Power Doppler (PD) and grey-scale (GS) US examination were done for all patients. PDUS score for synovitis in 22 joints and GS score for effusion/hypertrophy in 28 joints were included in US DAS calculation. ResultsThe mean age of the patients was 43.9±10.8years; 46 females and 4 males and the mean disease duration was 8.7±6.1years. The mean DAS28 was 5.04±1.2 and HAQ-DI was 1.2±0.7. The mean US DAS was 5.2±1.3 (2.11–7.21). According to the US DAS, patients with high activity had significantly prolonged morning stiffness, higher swollen and tender joint counts, patient and physician global assessment, DAS-28, HAQ-DI, and SENS compared to those with moderate activity or low activity/remission. The mean US erosion count (USEC) was 8.9±6.6 (0–18) and it was higher in patients with high disease activity (p=0.04). A significant correlation was found between USDAS with DAS28 and HAQ-DI. US DAS showed moderate correlation (r=0.5, p=0.001), while USEC showed a strong correlation (r=0.8, p<0.001) with SENS. ConclusionUS DAS is a feasible scoring system for use in daily rheumatologic practice. US DAS may reflect disease activity and disability. The association between US DAS and USEC with radiologic scoring reflects their ability to detect structural joint damage.

The development and optimisation of a quantitative physical fitness scoring system for use amongst Naval Service personnel.

A lack of research currently exists in relation to the current physical fitness testing system that is used within the Irish Naval Service, not only in relation to the tests that are used but also in relation to the scores that should be achieved in order to pass the test. As such the aim of this study was to select tests for various components of physical fitness and create a scoring system that could be used to assess individuals more comprehensively. Seventy-five individuals took part in the study (71 males, 4 females). Each participant completed a battery of physical tests analysing the following physical fitness components: flexibility, power, agility, strength, speed, anaerobic conditioning and aerobic conditioning. The mean score ± 0.67 and ± 1 standard deviations were used for the selection of categories. A six category scoring system was produced for each component of physical fitness. Scores were assigned to each category allowing a total cumulative score and an overall percentage of the total to be calculated. The categories are as follows: Score 5, Score 10, Score 15, Score 20, Score 25, Score 30. A quantitative scoring system has been produced that allows comprehensive physical fitness testing to be conducted. In order to achieve a complete picture of a participant's physical fitness, all tests outlined should be included in the testing process. However, the flexible nature of this system allows for tests to be included or excluded to suit the needs of an individual or organisation. The fact that the scoring system is quantitative, the time involved is relatively short, multiple participants can be tested simultaneously and the pass rates can be decided upon by the host organisation makes this system versatile and comparable across multiple jurisdictions.

Development of a biomarker scoring system for use in graft-versus-host disease.

Development of a biomarker scoring system for use in graft-versus-host disease.

Assessment of writing ability in secondary education: comparison of analytic and holistic scoring systems for use in large-scale assessments

Assessment of writing ability in secondary education: comparison of analytic and holistic scoring systems for use in large-scale assessments

A novel, disease-specific clinical global impression scale (CGI) in Down syndrome

Background The CGI receives criticism due to its ambiguous scoring criteria, unstable reliability, and because CGI ratings may be too general to provide meaningful information about patient status or treatment response. This is problematic in studies of neurodevelopmental disorders such as Down syndrome (DS) that violate key assumptions underlying the CGI (i.e., that the disease is potentially reversible) and are highly variable in observed impairments. In DS, the CGI requires a higher level of standardization. This study examined the psychometric properties of a novel standardized CGI scoring system for use in phase 2/3 clinical trials with DS populations. Methods Impairment in functional and adaptive behaviors in DS – speech, activities of daily living, functioning and non-compliance – were proposed as anchors for assessment in determining a global score of severity and improvement/deterioration. In a non-intervention study among individuals with DS ( n =90,M age=18.23, SD=23.27), the CGI was conducted with the ADAMS, CELF-2, CELF-4, BRIEF-P and VABS-II. Descriptive and comparative analyses were performed. Results At screening, the CGI-S speech, social functioning, and non-compliant domains correlated positively with ADAMS Social avoidance ( r =0.400, 0.272 and 0.294, respectively) supporting construct validity. The CELF negatively correlated with CGI-S Speech ( r =–0.469, P =0.037). The CGI-I correlated negatively with the VABS-II at Day 1, W4 and W24. Conclusions The CGI developed for Down syndrome (DS) is a valid clinical outcome measure. It offers a number of advantages including established utility in clinical research, sensitivity to change, and consistency with neurocognitive measures in DS.

Severity Scores in Emergency Department Patients With Presumed Infection: A Prospective Validation Study.

The objectives of this study were to 1) validate a number of severity of illness scores in a large cohort of emergency department patients admitted with presumed infection and 2) compare the performance of scores in patient subgroups with increasing mortality: infection without systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. Prospective, observational study. Adult emergency department in a metropolitan tertiary, university-affiliated hospital. Emergency department patients admitted with presumed infection. None. Consecutive emergency department patients admitted with presumed infection were identified over 160 weeks in two periods between 2007 and 2011. Clinical and laboratory data sufficient to calculate Mortality in Emergency Department Sepsis score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and the Severe Sepsis Score were entered into a database. Model discrimination was quantified using area under the receiver operating curve. Calibration was assessed using visual plots, Hosmer-Lemeshow statistics, and linear regressions of observed and predicted values. A total of 8,871 patients were enrolled with 30-day mortality of 3.7%. Area under the receiver operating curve values for the entire cohort were: Mortality in Emergency Department Sepsis score of 0.92, Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II scores of 0.90, Sequential Organ Failure Assessment score of 0.86, and Severe Sepsis Score of 0.82. Discrimination decreased in subgroups with greater mortality for each score. All scores overestimated mortality, but closest concordance between predicted and observed mortality was seen with Mortality in Emergency Department Sepsis score. The decrease in area under the receiver operating curve seen in subgroups with increasing mortality may explain some variation in results seen in previous validation studies. Scores developed in intensive care settings overestimated mortality in the emergency department. Our results underscore the importance of employing predictive models developed in similar patient populations. The Mortality in Emergency Department Sepsis score outperformed more complex predictive models and would be the most appropriate scoring system for use in similar emergency department populations with a wide spectrum of mortality risk.

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Learning Objectives: Current scoring systems for use in critical illness do not take into account levels of simultaneous physiological or pharmacological support. Yet, clinicians at the bedside subconsciously interpret cardiovascular parameters in the context of this support. In the acquisition of subconscious expertise it is established that it is better to observe an expert solve a problem in real time than to ask them to describe what they do in the abstract. Hypothesis: Using knowledge capture techniques it is possible to design a scale of the overall state of a critically ill patient underpinned by a sophisticated physiological rule base. Methods: Data sets were prepared from the Electronic Records of 10 patients with 2761 time points of routinely collected physiological and pharmacological parameters. A clinician scored each time point as stable (A) through to unstable (E) whilst simultaneously describing a rule set of ranges (A-E) of derangement for each parameter. The same time points were annotated automatically using the rule set described in the abstract and inconsistencies between the two sets of annotations compared in a confusion matrix. Each disagreement was analyzed and changes made to the rule base where appropriate to better capture clinical expertise. The process was repeated with two other clinicians, their clinical annotations being tested against the previous clinician’s rule set, resulting in further refinements. Results: Agreement between clinician 1’s final rule set and annotations post refinement was 96.7%. Agreement between clinician 1’s final rule set clinician 2’s initial annotations and was 10.7% (97.6% after refinement). Initial agreement between clinician 2’s final rule set and clinician 3’s initial annotations was 90.6% (98.1% after refinement - the final A to E rule set for the new score).Conclusions: There was a higher agreement between the final rule set of the first clinician and the initial annotations of each subsequent clinician as the refinement proceeded. It is possible to design a sophisticated rule base underpinning a physiological score using knowledge capture techniques.

IS-049 The Role Of Nursing Gut Instinct In Illness Identification And Early Warning Scores

<h3></h3> Increasing presentations to urgent and emergency care settings throughout the world have created a huge challenge for health services. Although ensuring that serious illness and injury is identified, and promptly treated, the large majority of children presenting have relatively minor problems. Developing systems, and education, to ensure that the right children are identified for further treatment and those that do not need hospitalisation are safely discharged will be vital as resources become increasingly limited. Within hospital identifying the child who requires an escalation of care is also important as there is a frequent pattern of ‘failure to recognise deterioration’ throughout the world. Various scoring systems – whether triage, early warning, illness identification or illness severity have been developed in children. The component of ‘gut feeling’ or gestalt is relatively unexplored however. This presentation will review current research on gut feeling and using the results of the implementation of the Paediatric Observation Priority Score, a bespoke scoring system for use in children’s urgent and emergency care, to explore how nurse’s gut feeling is an important factor in managing the acutely unwell or injured child in health care settings.

Novel endoscopic scoring system after sinus surgery.

To propose a simple post-operative endoscopic scoring system for use after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS), and to demonstrate the usefulness of this approach. Subjects comprised 116 patients (84 men, 32 women; mean age, 54 years) with CRS who were analyzed endoscopically and radiologically after ESS between 2006 and 2012. The study was designed as a case series with planned data collection in the setting of university medical centers. Patients were followed-up for ≥ 6 months after ESS (mean, 13.1 months). Both pre- and post-operative computed tomography (CT) findings of each sinus and olfactory cleft (OC) were scored according to the Lund-Mackay scoring system: 0, normal; 1, partially; or 2, completely occupied. CT score represents the total score expressed as a percentage of the maximum possible score (12 points per side). Post-operative endoscopic score (E score, %) was calculated as the maximum score according to physical findings on each operated sinus and OC: 0, normal; 1, partially diseased; or 2, completely closed. Post-operative course using E score was verified by comparison with the Lund-Kennedy (L-K) scoring system. E score was easily and quickly determined. Interclass correlation coefficient among 10 otolaryngologists indicated high-level inter-rater reliability (0.922). E score correlated strongly with both CT score (n=116, p<0.0001, rs=0.755) and L-K score (n=79, p<0.0001, rs=0.723). Endoscopic evaluation using E score for sinuses and OCs after ESS is a useful method, together with L-K score for the nasal cavity and radiological study.

Determination of the Optimal Echocardiographic Scoring System to Quantify Carcinoid Heart Disease

Background: Carcinoid heart disease (CHD) is an important complication of metastatic neuroendocrine disease, requiring regular monitoring to enable intervention prior to right heart failure. We aimed to identify the most appropriate echocardiographic scoring systems for the quantitative assessment of CHD. Methods: In this prospective study conducted between April and October 2012 in two European Neuroendocrine Tumor Society (ENETS) Centres of Excellence, patients with neuroendocrine tumours with liver metastases and/or carcinoid syndrome underwent transthoracic echocardiography and blood sampling for serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and plasma 5-hydroxyindoleacetic acid (5-HIAA). Each patient was assessed according to six echocardiographic scoring systems. The individual scoring systems' feasibility, observer variability, sensitivity, specificity and correlation with the concentration biomarkers were determined. Results: 100 patients were included; 21% had echocardiographic evidence of CHD. All scores discriminated highly between those with/without CHD, with no single score performing significantly better than another. The severity, determined using all of the scoring systems, correlated with the concentration of both biomarkers, but the strongest correlations were seen between the Bhattacharyya score and serum NT-proBNP. Conclusion: All scoring systems are comparable in terms of sensitivity and specificity for the detection of CHD. There is a variation in the feasibility of the scoring systems due to varying complexity of the score components. All scores correlate with NT-proBNP and plasma 5-HIAA. The Westberg score appears to be the most optimal scoring system for use in screening of CHD whereas the more complex scoring systems are more suited to the patient with established disease who may require surgical intervention.

A simple alopecia scoring system for use in colony management of laboratory‐housed primates

Alopecia in captive primates continues to receive attention from animal care personnel and regulatory agencies. However, a method that enables personnel to reliably score alopecia over time and under various conditions has proven difficult to achieve. The scoring system developed by the behavioral and veterinary staffs at the Washington National Primate Research Center (WaNPRC) uses the rule of 9s to estimate the percentage of the body affected with alopecia (severity) and how the alopecia presents itself (pattern). Training and scoring can conveniently be managed using photographic images, cage-side observations, and/or physical examinations. Personnel with varying degrees of experience were quickly trained with reliability scores ranging from 0.82 to 0.96 for severity and 0.82 to 0.89 for pattern using Cohen's κ. This system allows for reliable and consistent scoring across species, sex, age, housing condition, seasons, clinical or behavioral treatments, and level of personnel experience.

Urinary Prognostic Biomarkers and Classification of IgA Nephropathy by High Resolution Mass Spectrometry Coupled with Liquid Chromatography

IgA nephropathy is the most common cause of primary glomerulonephritis. There are different pathologic biopsy-based scoring systems in use, but there is no consensus among nephrologists yet regarding the best classification method. Our aim was to test urine proteomics as a non-invasive method for classification of IgA nephropathy. This aim was pursued by discovering novel prognostic protein biomarkers in urine, and linking them to pathogenesis of the disease through known signaling and metabolic pathways. 13 urine samples of the patients with biopsy-proven IgA nephropathy were analyzed via two proteomics approaches: nanoflow LC-MS/MS and GeLC-MS/MS. The results of label-free quantification were subjected to multivariate statistical analysis, which could classify patients into two groups, broadly corresponding to the primary and advance stages. The proteome classification correlated well with biopsy-based scoring systems, especially endocapillary hypercellularity score of the Oxford’s classification. Differentially excreted candidate proteins were found as potential prognostic biomarkers: afamin, leucine-rich alpha-2-glycoprotein, ceruloplasmin, alpha-1-microgolbulin, hemopexin, apolipoprotein A-I, complement C3, vitamin D-binding protein, beta-2-microglobulin, and retinol-binding protein 4. Pathway analysis suggested impairment of Extra Cellular Matrix (ECM)-Receptor Interaction pathways as well as activation of complement and coagulation pathway in progression of IgA nephropathy.

Instrumenting the Balance Error Scoring System for Use With Patients Reporting Persistent Balance Problems After Mild Traumatic Brain Injury

ObjectiveTo determine whether alterations to the Balance Error Scoring System (BESS), such as modified conditions and/or instrumentation, would improve the ability to correctly classify traumatic brain injury (TBI) status in patients with mild TBI with persistent self-reported balance complaints. DesignCross-sectional study. SettingOutpatient clinic. ParticipantsSubjects (n=13; age, 16.3±2y) with a recent history of concussion (mild TBI group) and demographically matched control subjects (n=13; age, 16.7±2y; control group). InterventionsNot applicable. Main Outcome MeasuresOutcome measures included the BESS, modified BESS, instrumented BESS, and instrumented modified BESS. All subjects were tested on the noninstrumented BESS and modified BESS and were scored by visual observation of instability in 6 and 3 stance conditions, respectively. Instrumentation of these 2 tests used 1 inertial sensor with an accelerometer and gyroscope to quantify bidirectional body sway. ResultsScores from the BESS and the modified BESS tests were similar between groups. However, results from the instrumented measures using the inertial sensor were significantly different between groups. The instrumented modified BESS had superior diagnostic classification and the largest area under the curve when compared with the other balance measures. ConclusionsA concussion may disrupt the sensory processing required for optimal postural control, which was measured by sway during quiet stance. These results suggest that the use of portable inertial sensors may be useful in the move toward more objective and sensitive measures of balance control postconcussion, but more work is needed to increase sensitivity.