Assessment of patients with mild concussion in the emergency department

OBJECTIVES: (1) to test the validity of the Standardized Assessment of Concussion (SAC) in characterizing the early evolution of concussion-related symptoms and mental status changes in the emergency department (ED) setting and (2) to compare it to the Conner's Continuous Performance Test 2nd Edition (CPT-II). DESIGN: Prospective within-subject (repeated measures) design. PARTICIPANTS: Sixty-two persons with concussion (Glasgow Coma Scale = 15) and negative head computed tomographic scan results were examined on arrival in the ED and 3 and 6 hours later. SETTING: A large urban, tertiary medical center ED. MAIN OUTCOME MEASURES: SAC; CPT-II; Post-Concussion Symptom Scale-Revised (PCS-R). RESULTS: SAC and CPT-II scores improved significantly over the time course in the ED. Symptoms did not correlate with improvement, with many subjects complaining of headache or nausea after their scores improved. The average initial score on the SAC was 21 ± 5.4/30. Conclusion: The SAC appears sensitive to the acute changes following concussion. It may be a useful tool for clinicians in detecting mental status changes after a concussion, when Glasgow Coma Scale and radiologic findings are normal.