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Using sideline concussion tests in the emergency department

Authors Kruse AJ, Nugent AS, Peterson AR

Received 20 February 2018

Accepted for publication 30 May 2018

Published 26 September 2018 Volume 2018:10 Pages 113—121


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Hans-Christoph Pape

Adam J Kruse,1 Andrew S Nugent,2 Andrew R Peterson3

1Carver College of Medicine, The University of Iowa, Iowa City, IA, USA; 2Department of Emergency Medicine, The University of Iowa, Iowa City, IA, USA; 3Department of Pediatrics, The University of Iowa, Iowa City, IA, USA

Purpose: Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Many patients with TBI are initially treated in the emergency department (ED), but there is no evidence-based method of detecting or grading TBI in patients who have normal structural neuroimaging. This study aims to evaluate the validity of two common sideline concussion tests. The Concussion Symptom Severity Score (CSSS) and modified Balance Error Scoring System (mBESS) tests are well-validated sideline tests for concussion, but have not been validated in the setting of non-sport-related concussion, in settings other than the sideline or athletic training room or in moderate or severe TBI.
Patients and methods: One hundred forty-eight subjects who had sustained a TBI within the previous 72 hours and 53 healthy control subjects were enrolled. CSSS and mBESS were administered. Clinical outcomes were followed up prospectively.
Results: The CSSS was collected in 147 TBI subjects but only 51 TBI subjects were able to complete the mBESS. The CSSS was collected for all 53 control subjects, and the mBESS was completed for 51 control subjects. The mean CSSS for TBI and control subjects was 32.25 and 2.70, respectively (P < 0.001). The average mBESS for TBI and control subjects was 7.43 and 7.20, respectively (P = 0.82). CSSS greater than 5.17 was 93.43% sensitive and 69.84% specific for TBI.
Conclusion: The mBESS is poorly tolerated and, among those who can complete the test, not sensitive to TBI in the ED. The CSSS is both sensitive to TBI and well tolerated.

Keywords: traumatic brain injury, balance, emergency room, Sport Concussion Assessment Tool, concussion symptom severity score, modified balance error scoring system

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