BACKGROUND Numerous medical organizations recommend a multifaceted approach to the assessment of concussion occurring during sporting events. A number of tools are available to clinicians, with a wide breadth of sensitivity and specificity; however, little work has been done to evaluate the combined efficiency of these tools in concussed male and female athletes from a broad array of collegiate sports and with variable time from the pre-season baseline evaluation. OBJECTIVE The aim of this study was to optimize the concussion assessment battery for application within the first 72 h of injury, and to identify the necessary baseline retesting frequency. METHODS Between 2014 and 2017, a total of 1458 National Collegiate Athletic Association (NCAA) athletes sustaining 1640 diagnosed concussions completed a baseline assessment each year of the investigation and were evaluated up to three times within the first 72 h of injury using a standardized assessment protocol. Classification and regression tree analyses were implemented to identify the most efficient multifaceted assessment pathway to quantify concussion-related outcomes. Results were optimized for assessments occurring within 1 h post-injury, 1-24 h post-injury, and 24-72 h post-injury when using the raw post-injury assessment performance, difference scores from baseline evaluations occurring in the same year, and difference scores from baseline evaluations occurring the year prior. RESULTS At each of the assessment time points, the analyses indicated that alone or in combination, a symptom evaluation, Balance Error Scoring System (BESS) scores collected on the firm surface, and Standardized Assessment of Concussion (SAC) total score offered the best overall performance when compared with pre-morbid performance captured in the same season. Optimized sensitivity of the multifaceted approach was 61% within 1 h of injury, 67% at the 1-24 h interval, and 55% at the 24-72 h interval when difference scores from the same-season baseline were available. CONCLUSIONS This investigation identified key concussion assessments in quantifying post-concussion performance among student athletes, that were maximized when same-season pre-morbid evaluations were available. Consistent with clinical recommendations, medical professionals should continue to focus on symptom reporting, postural control, and neurocognitive screening to support the clinical examination when making a concussion diagnosis.

中文翻译：

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急性运动脑震荡评估的优化：来自CARE联盟的前瞻性评估。

背景技术许多医疗组织建议采用多方面的方法来评估体育赛事期间发生的脑震荡。临床医生可以使用许多工具，它们具有广泛的敏感性和特异性。但是，很少有工作来评估这些工具在大范围大学运动中以及从季前基线评估以来时间可变的情况下，在脑震荡的男性和女性运动员中综合使用这些工具的效率。目的本研究的目的是优化脑震荡评估电池，以在受伤的前72小时内应用，并确定必要的基线复测频率。方法2014年至2017年，每年调查共有1,458名美国国家大学体育协会（NCAA）的运动员接受1640例脑震荡的诊断，完成基线评估，并在受伤的前72小时内使用标准化评估方案进行了多达3次评估。实施分类和回归树分析以识别最有效的多方面评估途径，以量化脑震荡相关结果。当使用原始受伤后评估表现时，针对受伤后1小时内，受伤后1-24小时内和受伤后24-72小时内进行的评估，结果进行了优化，与当年基线评估的差异得分以及前一年进行的基线评估得出的差异分数。结果在每个评估时间点，分析表明，与捕获的病前表现相比，单独或结合使用症状评估，在公司表面收集的平衡误差评分系统（BESS）分数和脑震荡标准化评估（SAC）的总分数可提供最佳的总体表现在同一个季节。当可获得与同一季节基线的差异分数时，多方面方法的最佳敏感性在受伤1小时内为61％，在1-24小时间隔为67％，在24-72小时间隔为55％。结论这项研究确定了量化学生脑震荡后表现的关键脑震荡评估，当有同季病前评估可用时，这些评估将最大化。根据临床建议，医疗专业人员应继续专注于症状报告，