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Prospective Clinical Assessment Using Sideline Concussion Assessment Tool-2 Testing in the Evaluation of Sport-Related Concussion in College Athletes

Putukian, Margot MD*,†; Echemendia, Ruben PhD‡,§; Dettwiler-Danspeckgruber, Annegret EdD; Duliba, Tawny; Bruce, Jared PhD; Furtado, John L. PT, ATC*; Murugavel, Murali PhD

Clinical Journal of Sport Medicine: January 2015 - Volume 25 - Issue 1 - p 36–42
doi: 10.1097/JSM.0000000000000102
Original Research

Objective: To evaluate the utility of the Sideline Concussion Assessment Tool (SCAT)-2 in collegiate athletes with sport-related concussion.

Design: Prospective cross-sectional study with baseline testing and serial repeat testing after concussion in contact sport athletes and non-concussed control athletes.

Setting: Division I University.

Participants: Male and female club rugby and varsity athletes.

Interventions: Baseline measures of concussion symptoms, cognitive function, and balance were obtained using the SCAT-2. Serial postinjury testing was conducted as clinically indicated.

Main Outcome Measures: The SCAT-2 total and subset scores were calculated and evaluated at baseline and after injury.

Results: The total SCAT-2 score and the composite scores of symptoms, symptom severity, and balance were significantly different in concussed groups after injury when compared with baseline. When comparing performance in concussed versus control athletes, all subcomponents of the SCAT-2 were significantly different. No differences in baseline SCAT-2 scores were seen based on self-reported history of concussion. At baseline, anxiety and depression screening scores were associated with higher symptom scores. When compared with baseline, a 3.5-point drop in SCAT-2 score had 96% sensitivity and 81% specificity in detecting concussion. When examined to exclude baseline scores, a cutoff value of 74.5 was associated with 83% sensitivity and 91% specificity in predicting concussion versus control status.

Conclusions: The SCAT-2 total composite score and each subcomponent are useful in the assessment of concussion. As SCAT-3 is similar to SCAT-2, it is expected that it too will be a useful tool.

*Princeton University, Athletic Medicine, University Health Services, Princeton, New Jersey;

Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Princeton, New Jersey;

Department of Psychology, University of Missouri—Kansas City, Kansas City, Missouri;

§University Orthopedics Comprehensive Concussion Care Clinic, State College, Pennsylvania; and

Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey.

Corresponding Author: Margot Putukian, MD, University Health Services, Princeton University, Washington Rd, Princeton, NJ 08544 (

Supported by the American Medical Society for Sports Medicine Foundation and the New Jersey Commission on Brain Injury Research.

All authors participated in the design, implementation, and/or review of the manuscript. M. Putukian reports nonfinancial support from National Football League Head Neck and Spine Committee, US Lacrosse Sports Science Safety Committee, and National Collegiate Athletics Association during the conduct of the study. R. Echemendia reports personal fees from Princeton University and personal fees and nonfinancial support from National Hockey League and Major League Soccer during the conduct of the study. J. Bruce reports personal fees from Princeton University, National Hockey League, and Archives of Clinical Neuropsychology during the conduct of the study. The remaining authors report no conflicts of interest.

Received July 17, 2013

Accepted January 10, 2014

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