2.11 The diagnostic accuracy and reliability of the 10-word standardized assessment of concussion and the modified balance error scoring system for acute diagnosis of concussion

• Published in: British journal of sports medicine 2024-01, Vol.58 (Suppl 1), p.A76-A76
• Main Authors: Harmon, Kimberly G, Bohr, Adam D, Aukerman, Doug F, Elkinton, Heather A, Garruppo, Gabrielle, Holliday, Marissa, Hwang, Calvin E, Poddar, Sourav K, Whelan, Bridget M
• Format: Article
• Language: English
• Subjects: Accuracy; Athletes; Concussion; Second Round Abstract Submissions
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2023-concussion.202

ObjectivePrevious studies have shown the 5-word Standardized Assessment of Concussion (SAC) and modified-Balance Error Scoring System (mBESS) have poor diagnostic accuracy. The purpose of this study was to assess test-retest reliability, sensitivity/specificity, and AUC of the 10-word SAC and mBESS.DesignProspective, case-control.SettingFour NCAA Division I universities.ParticipantsConcussed/matched-control varsity athletes.InterventionsAthletes completed baseline testing including the 10-word SAC and mBESS. When an athlete presented with suspected concussion from February 2020 to April 2022 (sideline/within 24 hours), a battery of tests were performed. If a concussion was diagnosed, a control was identified to test, matched on comorbid conditions (attention deficit disorder, learning disability, headache disorder, mood disorder), gender, team, season, and baseline scores.Outcome MeasuresSAC scores and mBESS scoresMain ResultsBaseline and post-injury data were collected on 85 concussed and 85 matched control athletes (n=66 SAC; n=85 mBESS). Athletes were predominantly male (n=112, 55%), with the largest sport distributions amongst football (n=78, 39%), volleyball (n=24, 12%), softball (n=22, 11%), and baseball (n=11, 6%). For the SAC, the test-retest reliability (ICC) was 0.26 (95% CI: 0.04–0.46); average of 286.6 days between assessments); sensitivity/specificity was 58%/76% (1-point decline), 55%/83% (2-point decline), 48%/85% (3-point decline); area under the curve (AUC) was 0.71 (0.52–0.77). For the mBESS, the ICC was 0.50 (95% CI: 0.32–0.64; average of 308.2 days between assessments); sensitivity/specificity was 44%/83% (3-point increase), 26%/94% (5-point increase), 11%/NA% (8-point increase); AUC was 0.66 (0.58–0.74).ConclusionsThe 10-word SAC and mBESS have poor diagnostic accuracy in isolation.