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Papers of the Week

2022 May


36 Suppl 1

The Effects of Exercise on the Sport Concussion Assessment Tool 3 (SCAT3).


Iring S, Favre M, Tosto-Mancuso J, Ratnakumar N, Lozhkin A, Falvo M, Serrador J
FASEB J. 2022 May; 36 Suppl 1.
PMID: 35553362.


There are 3.8 million sports-related concussions reported annually. Although there is a growing number of sports-related concussions, there is a lack of evidence-based methods to evaluate, treat, predict, and monitor recovery in athletes. Today, concussions are clinically diagnosed using self-reported symptoms and by examining posture, neurocognition, ocular/vestibular control, and various imaging techniques. The Sport Concussion Assessment Tool (SCAT) is widely used on the sideline along with other methods to diagnose a concussion. However, current studies use control groups that are rested (i.e baseline) without considering the effect of intense exercise and contact (not related to head) that a player may have experienced during a game. To obtain this data we developed a mobile tent-based laboratory that permits us to collect data on the field during a rugby match. SCAT3 questionnaires were performed within 3 hours following a rugby match in players who experienced a head injury or completed the match without a head injury. Additional measures included beat-by-beat blood pressure (Finometer), heartrate, common and internal carotid blood flow, and end-tidal CO2 (nasal cannula) during rest, in the seated and supine position. A principal component analysis was performed on the 26 listed symptoms on the SCAT3 and Mann-Whitney U-test on the resulting 4 components. There were a total 209 players (67 female, 142 males; 33 ± 13 years) who just played a match, with 80 who experienced a head injury and 129 controls. Self-reported symptoms were significantly greater in players who experienced a head injury 26.16 ± 17.6 vs control 8.93 ± 11.5, P<.001. A principal component analysis on our entire dataset produced 4 symptom components: (1) Cognitive-Sensory (2) Emotional-Affective (3) Hypersensitive (4) Headache. A Mann-Whitney U-tests showed significant differences between the concussed and control groups for the following symptom components: Cognitive-Sensory (p<0.001), Headache (p<0.001), Emotional-Affective (p<0.004), and Hypersensitive (p<0.001). This data suggests that the SCAT3 symptoms were greater in the players with a head injury, but that some of the control players who just played an intense match also show an increased number of symptoms and severity. Further analysis and violin plots on each of the 4 components showed that the symptom component named "Headache" composed of; Pressure in the Head, Headache, Feeling Slowed down, Dizziness, Don't Feel Right may provide a better indicator of concussion in players that just played an intense match. Future work is needed to examine how these components can be used along with current physiological measures to better assess a concussion in players that just came off the field.