Reliability and Validity of the Sport Concussion Assessment Tool-3 (SCAT3) in High School and Collegiate Athletes
Reliability and Validity of the Sport Concussion Assessment Tool-3 (SCAT3) in High School and Collegiate Athletes
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DOI：
10.1177/0363546516648141
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发表时间：
2016-09-01
影响因子：
4.8
通讯作者：
McCrea, Michael A.
中科院分区：
文献类型：
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作者：
Chin, Esther Y.;Nelson, Lindsay D.;McCrea, Michael A.
背景：运动性脑震荡评估工具-3（SCAT 3）有助于脑震荡运动员的副业临床评估。然而，很少有发表的研究临床相关指标SCAT 3作为一个整体。目的：我们记录了心理测量学的主要SCAT 3组件的属性（症状、认知、平衡）和衍生的临床决策标准（即，可靠的变化分数截止值和规范性对话表），以供临床医生应用于有和没有可用的伤前基线数据的病例。方法：高中和大学运动员（N = 2018）完成季前赛基线评估，包括SCAT 3。166名受伤运动员和164名未受伤的对照组在受伤后24小时内以及受伤后8、15和45天进行了重新评估。分析的重点是基线性能的预测因素，重测信度，以及SCAT 3的敏感性和特异性，使用单一的损伤后截止值或来自该样本的可靠变化指数（RCI）标准。运动员性别，比赛水平，注意力缺陷/多动障碍（ADHD），学习障碍（LD），和估计的语言智力能力（但不是脑震荡史）与SCAT 3 1个组成部分的基线评分相关（小到中等效应量）。女性、高中水平的比赛（与大学相比）和ADHD与较高的基线症状评分相关（d = 0.25-0.32）。男性、ADHD和LD与较低的基线标准化脑震荡评估（SAC）评分相关（d = 0.28-0.68）。男性、高中水平的比赛、ADHD和LD与基线平衡误差评分系统（BESS）表现较差相关（d = 0.14-0.26）。损伤后，症状自评量表在24小时评估时表现出最大的效应量（d = 1.52），组间差异减小，但在第8天具有统计学显著性（d = 0.39），在第15天无显著性。SAC和BESS的效应量在24小时时为小至中等（SAC：d = -0.36;改良BESS：d = 0.46;完全BESS：d = 0.51），在第8天（SAC）和第15天（BESS）变得不显著。受试者工作特征曲线分析表明，症状（曲线下面积[AUC] = 0.86）比认知和平衡测量（AUC分别为0.58和0.62）更强的区分力，单独使用损伤后评分与基线调整评分对每个SCAT 3组分的区分力相当（P = 0.71 - 0.90）。规范的转换表和RCI标准的创建，以方便使用SCAT 3与基线和无testingresults.Conclusion：个别预测因素应考虑在解释SCAT 3。鉴于两种解释方法的可比性，提出的规范转换表和RCI可用于帮助解释脑震荡运动员在有和没有基线数据的情况下的表现。
Background: The Sport Concussion Assessment Tool-3 (SCAT3) facilitates sideline clinical assessments of concussed athletes. Yet, there is little published research on clinically relevant metrics for the SCAT3 as a whole.Purpose: We documented the psychometric properties of the major SCAT3 components (symptoms, cognition, balance) and derived clinical decision criteria (ie, reliable change score cutoffs and normative conversation tables) for clinicians to apply to cases with and without available preinjury baseline data.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: High school and collegiate athletes (N = 2018) completed preseason baseline evaluations including the SCAT3. Re-evaluations of 166 injured athletes and 164 noninjured controls were performed within 24 hours of injury and at 8, 15, and 45 days after injury. Analyses focused on predictors of baseline performance, test-retest reliability, and sensitivity and specificity of the SCAT3 using either single postinjury cutoffs or reliable change index (RCI) criteria derived from this sample.Results: Athlete sex, level of competition, attention-deficit/hyperactivity disorder (ADHD), learning disability (LD), and estimated verbal intellectual ability (but not concussion history) were associated with baseline scores on 1 SCAT3 components (small to moderate effect sizes). Female sex, high school level of competition (vs college), and ADHD were associated with higher baseline symptom ratings (d = 0.25-0.32). Male sex, ADHD, and LD were associated with lower baseline Standardized Assessment of Concussion (SAC) scores (d = 0.28-0.68). Male sex, high school level of competition, ADHD, and LD were associated with poorer baseline Balance Error Scoring System (BESS) performance (d = 0.14-0.26). After injury, the symptom checklist manifested the largest effect size at the 24-hour assessment (d = 1.52), with group differences diminished but statistically significant at day 8 (d = 0.39) and nonsignificant at day 15. Effect sizes for the SAC and BESS were small to moderate at 24 hours (SAC: d = -0.36; modified BESS: d = 0.46; full BESS: d = 0.51) and became nonsignificant at day 8 (SAC) and day 15 (BESS). Receiver operating characteristic curve analyses demonstrated a stronger discrimination for symptoms (area under the curve [AUC] = 0.86) than cognitive and balance measures (AUCs = 0.58 and 0.62, respectively), with comparable discrimination of each SCAT3 component using postinjury scores alone versus baseline-adjusted scores (P = .71-.90). Normative conversion tables and RCI criteria were created to facilitate the use of the SCAT3 both with and without baseline test results.Conclusion: Individual predictors should be taken into account when interpreting the SCAT3. The normative conversion tables and RCIs presented can be used to help interpret concussed athletes' performance both with and without baseline data, given the comparability of the 2 interpretative approaches.