Abstract
Objectives
Current off-field concussion screening instruments have sub-optimal accuracy and additional
testing domains may be necessary to detect the full spectrum of concussion presentations.
This study aimed to determine if additional cognitive tests add utility to off-field
screening for sport-related concussion.
Design
Reproducibility and diagnostic accuracy cohort studies were performed in the 2017
and 2018 seasons of the Super Rugby competition, conducted in Argentina, Australia,
Japan, New Zealand, and South Africa.
Methods
Abridged versions of Stroop (score, time), Spatial Memory (score, failed trials),
and Trail Making Trial-B (time, errors) cognitive tests, modified for off-field use,
were examined. Players performed baseline testing prior to each season. Cases undergoing
off-field screening as part of the World Rugby Head Injury Assessment Process underwent
evaluation with the same cognitive tests during competition matches. Agreement between
repeated pre-season baseline measurements, and the diagnostic accuracy of off-field
testing against a clinical reference standard of concussion, was evaluated.
Results
Data were available for repeated preseason baseline testing in 644 players, and 100
cases undergoing off-field concussion screening. There was little individual agreement
across pre-season baseline assessments for all tests (Lin's correlation and Gwets
AC1 coefficients ranging between 0.2 and 0.3). There was significantly worse performance
for the time taken to complete the modified Stroop Test in concussed players undergoing
off-field screening, compared to non-concussed players (median time 21.1 v 18.4 s,
p < 0.01; area under the receiver operating characteristic curve 0.7 (95% CI 0.5–0.8)).
Other cognitive measures did not discriminate between injured and un-injured players,
with no-statistically significant differences in distribution medians (p = 0.6–0.9)
and AUROC values close to 0.5.
Conclusions
The time taken to perform a modified Stroop Test may provide additional diagnostic
accuracy if added to current off-field concussion screening tools. Abridged Spatial
Memory and Trail Making Trial-B tests did not discriminate between concussed and non-concussed
players.
Keywords
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Article info
Publication history
Published online: June 11, 2021
Accepted:
June 3,
2021
Received in revised form:
March 30,
2021
Received:
June 30,
2020
Identification
Copyright
© 2021 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
