The Clinical Utility of a Novel Multimodal Assessment Battery for Acute Sport-Related Concussion

OBJECTIVE: Determine the clinical utility of a novel, multimodal assessment battery in detecting acute post-concussion impairment relative to baseline performance. DESIGN: Prospective observational cohort study. SETTING: Outpatient Concussion Clinic. PARTICIPANTS: Four hundred thirty-one ice hockey, alpine ski, freestyle ski, artistic swimming, and luge athletes (mean: 15.7 years) over one athletic season. INDEPENDENT VARIABLES: Concussion status. MAIN OUTCOME MEASURES: Changes in performance between baseline and post-concussion for 4 primary assessments: (1) concussion symptom exacerbation (≥1 on a 10-point scale) during a submaximal exercise assessment, (2) eyes closed and eyes open postural sway ratio (Ec/Eo) using a head mounted accelerometer, (3) quantitative electroencephalography event-related potentials (ERPs) N100, P300, and N400 amplitude and latency, and (4) change in heart rate during a 30-second, 30% maximal handgrip contraction. RESULTS: Forty-six athletes with a diagnosed concussion were enrolled. The exercise assessment found that 15 of the 22 athletes experienced worsening symptoms ( P < 0.001, large effect size for the raw proportion (PR) = 0.969). Postural sway between timepoints showed a moderate effect size (d av = 0.491) (baseline: 1.4 ± 0.5 W, post-concussion: 1.9 ± 1.4 W, P = 0.005). Neither ERPs nor heart rate change during the handgrip task demonstrated significant group differences. Of 21 athletes with both postural sway and exercise evaluations, a flagged postural sway ratio (Ec/Eo ≥ 2.0) was seen for 3 athletes not previously identified by the exercise evaluation. CONCLUSIONS: Symptom exacerbation during submaximal cardiovascular exercise and postural sway demonstrated clinical utility in detecting impairment within 7 days of a sport-related concussion, whereas event-related potentials and heart rate change during sustained handgrip did not.