The Standardized Assessment of Concussion (SAC) is a concussion screening tool used in identifying concussions by measuring performance decreases compared with baseline scores. This places great importance on valid baseline and postinjury scores. The objective was to examine baseline psychometric properties of SAC items using item analysis. One hundred fortyseven healthy adults (n = 72 men, n = 75 women; age =18-59 years) completed all 3 SAC versions in random block order. Item analysis examined item difficulty (.1 > P .1). Acceptable items met both criteria. All 3 SAC versions had few acceptable items (A = 33%, B = 30%, C = 27%). Most items were too easy (76%). No orientation, 7% of immediate memory, and 60% of concentration were acceptable. Most SAC items have unacceptable psychometric properties when used to establish baseline cognitive abilities, which questions the validity for postinjury score comparisons. Mild traumatic brain injuries (MTBI), also known as concussions, are a serious concern that affect athletes and the general public.1 A traumatic brain injury is defined as a blow or penetrating force to the head, which leads to a disruption of normal brain function.2 Mild traumatic brain injuries account for 85% of the 1.5 million head injuries that occur annually throughout the United States; approximately 300,000 of these occur in sport-related activities.3,4 Langlois et al5 have reported that sport-related traumatic brain injuries are severely underestimated. They estimated that approximately 1.6 to 3.8 million sport-related traumatic brain injuries occur each year. Memory, attention, and information processing are some of the cognitive functions that are affected by MTBI.6-9 The accurate measurement of these functions is vital for health care professionals to identify and manage MTBI. It is important to use standardized tests for the assessment of an individual’s cognitive status and severity after sustaining an MTBI. Several brief diagnostic screening tools have been developed that can be used to evaluate changes in an individual’s cognitive status. For example, the Mini-Mental Status Examination (MMSE)10 is commonly used with older adults and other cognitively impaired populations. In sports medicine, the Standardized Assessment of Concussion (SAC) was created to provide team physicians, athletic trainers, and other medical professionals involved in the care of sport-related MTBI with a quick standardized, objective, screening tool for use on the field.11-13 Unlike the MMSE, which uses a criterion-referenced standard14 (ie, cut-score) for identification of cognitive dysfunction, the SAC uses an individual-centered standard. This approach is used in sport-related MTBI assessment protocols and is recommended by the National Athletic Trainers’ Association.15,16 The individual-centered standard requires testing to document the athlete’s baseDr Ragan is from the Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio; Mr Herrmann is from the Healthy Lifestyles Research Center Program in Exercise & Wellness, Arizona State University, Mesa, Ariz; Dr Kang is from the Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tenn; and Dr Mack is from the School of Health, Physical Education & Leisure Services, University of Northern Iowa, Cedar Falls, Iowa. Originally submitted February 18, 2009. Accepted for publication May 18, 2009. The authors have no financial or proprietary interest in the materials presented herein. Presented in part at the National Athletic Trainers’ Association Annual Meeting; June 2007; Anaheim, California. The authors thank Karen Kirkwood, Whitney Harris, and Ranae Abel for their help with the data collection. Address correspondence to Brian G. Ragan, PhD, ATC, Department of Family Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7136; e-mail: brian.ragan@case.edu. doi:10.3928/19425864-20090625-07
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Mar 11, 2014
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