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• Posted June 11, 2024

Study Casts Doubt on Standard Test for Athletes' Concussion

A test used to gauge whether a college athlete has suffered a concussion is right only half the time and may be useless, new research finds.

The test used by the NCAA, which oversees college sports, measures an athlete's cognitive skills, and is one of three tests (symptoms and balance tests being the other two) that doctors use to identify concussion.

"If you don't do well on the cognitive exam, it suggests you have a concussion. But many people who are concussed do fine on the exam,"said study lead author Dr. Kimberly Harmon. She is a professor of family medicine and section head of sports medicine at the University of Washington School of Medicine.

Harmon said she was prompted to conduct the study by firsthand experience working on the sidelines as team physician for the UW Huskies.

"Some people were concussed and they did well on the recall tests. Some people weren't concussed and they didn't do well. So I thought we should study it,"she explained in a UW news release.

The test itself is one part of what's known as the Sport Concussion Assessment Tool (SCAT). In the cognitive skills section of SCAT, the patient is asked "orientation" questions (What day is it? What month is it?), then a memory test (recite back a list of words), then a concentration challenge (repeat a series of numbers in reverse order).

Tests for a range of concussion symptoms, plus a balance test, make up the other two-thirds of the SCAT exam.

The new study involved 92 NCAA Division I athletes who sustained a concussion between mid-July of 2020 and the end of 2022. All had undergone a concussion evaluation within 48 hours of injury.

Their SCAT results were compared to those of 92 (non-injured) teammates.

Harmon's team found no difference in cognitive test scores between the injured and non-injured athletes. In fact, 45% of players who were found to have a concussion actually performed better on their cognitive tests than in a "baseline" test before the concussion, researchers noted. 

"If you get hit in the head and go to the sideline and say, 'I have a headache. I'm dizzy. I don't feel right,' I can say with pretty good assurance that you have a concussion,"Harmon said. 

"I don't need to do any [cognitive] testing," she reasoned. "The problem is that some athletes don't want to come out. They don't report their symptoms or may not recognize their symptoms. So then you need an objective, accurate test to tell you whether you can safely put the athlete back on the field. We don't have that right now."

She said that keeping athletes safe requires real teamwork between health care staff and the athletes themselves.

"Although an increase in symptoms is highly suggestive of concussion, this relies on accurate reporting by the athlete who may not report symptoms because of a desire to return to play, a fear of letting teammates down, minimizing the seriousness of concussion, difficulty discerning symptoms, a delay in symptom development, or other reasons," Harmon said.

"We are still short of the holy grail, which is an objective test for concussion,"she said. "For now, this study shows how important it is for athletes to disclose their symptoms." 

The study was published June 11 in JAMA Network Open.

More information

Find out more about concussion diagnosis at NYU Langone Health.

SOURCE: University of Washington, news release, June 11, 2024