The consideration of post-exercise impact on SCAT3 scores in athletes immediately following a head injury

ABSTRACT

Examine effects of high-intensity exercise and physical impacts during rugby match on self-report symptoms in The Sport Concussion Assessment Tool (SCAT3), and its ability to differentiate head-injured players from controls.

Methods

Symptoms were assessed immediately following completion of a rugby match (median 60 minutes). Players removed from the match for assessment due to a head hit were classified as head injured. Controls completed match without head hit.

Results

209 players (67 female; 33 ± 13 years) participated with 80 experiencing a head injury. Symptom severity was significantly greater in head injured (26.2 ± 17.6) compared with controls (8.9 ± 11.5, P < 0.001). 21% of control players reporting >16 symptom severity, misclassifying them as suspected concussion. There were no significant sex differences. Factor analysis produced four symptom clusters of which Headache was most discriminatory between the head injured (median = 1.7) and controls (median = 0.0).

Conclusion

These findings demonstrate that exercise and contact during a game affect symptom assessment, increasing the likelihood of misclassifying players with suspected concussion. Factor characterization of symptoms associated with head injury using an exercised comparison group provides more useful discrimination. These results highlight the necessity for objective measures to diagnose concussions outside of symptom self-report.

KEYWORDS:

• Concussion
• post-exercise
• sport concussion assessment tool (SCAT)
• standardized assessment of concussion (SAC)
• balance error scoring system (BESS)

Acknowledgements

Authors wish to thank the many rugfby players who attended the CanAm rugby tournament that donated their time and support for the study. We would also like to thank the organizers of the tournament and the Mountaineers Rugby Club for inviting us to participate. Authors also gratefully acknowledge Professor Anne Crecelius, Phd, Allan Knox PhD, Levy Reyes PhD; Apollonia Fox PhD, Melissa Blatt RN, Valentin Siderskiy, Thuy Tien Le, Kelly Brewer, Paige Kompa, Melissa McSwain, Bishoy Sammy, Lesley de la Cruz, Kamala Migdal, Justyna Michalik, Jacqueline Klein, Amanda Acosta, Bemin Ghobreal, Dolu Mosadouwa and Faria Sanjana for their contributions to this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2023.2184868

Additional information

Funding

This work was supported by the NIGMS of the National Institutes of Health under award number 5T32GM140951; the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR003019. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.