Does the Concussion Clinican Examination Predict Post-Concussion Subsequent Musculoskeletal Injury?
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Abstract
Objective To identify post-concussion subsequent lower extermity musculoskeletal injury predictors from a clinical concussion assessment.
Background Emerging evidence has identified an elevated risk of subsequent lower extremity musculoskeletal injury (LE-MSK) in the year post-concussion. This approximately 2-fold elevated risk has been identified in diverse populations including high school, college, professional sports and military populations. While persistent impairments in postural control are a speculated mechanism, these assessments require instrumented biomechanical measures; thus, there are currently no clinically feasible predictors which have been identified.
Design/Methods Eighty three NCAA Division I student-athletes (51.8% female, ht: 1.75 +/− 0.12 m, wt: 76.2 +/− 20.1 kg) who had suffered a sports related concussion (LOC: 7.5%, PTA: 12.2%) with baseline data were assessed within 72 hours post-concussion were included in this retrospectic study. The clinical examination consisted of the Balance Error Scoring System (BESS), Standard Assessment of Concussion (SAC), Clinical Reaction Time (CRT), King-Devick (KD) and the Immediate Post-Concussion Assessment and Cognitve Test (ImPACT) composite values. Change scores (Δ) from baseline to acute post-concussion served as predictors to identify subsequent LE-MSK with a step wise binary logistic regression.
Results The subsequent LE-MSK rate was 72.3% (60/83). The overall model failed to identify a predictive relationship between change scores and subsequent injury risk (r2 = 0.242, p = 0.458). Exploratory testing failed to identify any significant individual predictors of subsequent LE-MSK: BESS: Δ = −0.35 errs, p = 0.964; SAC: Δ = −0.55, p = 0.239; ImPACT Verbal Memory: Δ = −0.53, p = 0.324; ImPACT Visual Memory: Δ = −5.6, p = 0.750; ImPACT Motor Speed: Δ = −2.81, p = 0.070; ImPACT Reaction Time: Δ = 0.042 sec, p = 0.164; CRT: Δ = 12.2 ms, p = 0.564; and KD: Δ = 2.8 sec, p = 0.607.
Conclusions None of the common clinical concussion assessments were a significant predictor of subsequent LE-MSK potentially due to a high injury rate (72.3%). Future research should continue attempts to idenify clinically feasible predictors to allow clinicians to identify at-risk athletes to engage injury prevention strategies to reduce subsequent LE-MSK.
Footnotes
Study Supported By: NIH/NINDS: R03NS104391.
Disclosures: Dr. Buckley has nothing to disclose. Dr. Oldham has nothing to disclose. Dr. Getchell has nothing to disclose. Dr. Swanik has nothing to disclose. Dr. Lynall has nothing to disclose. Dr. Howard has nothing to disclose.
- © 2019 American Academy of Neurology
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