The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study

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dc.contributor.authorFuller, G. W
dc.contributor.authorTucker, R.
dc.contributor.authorStarling, L.
dc.contributor.authorFalvey, E.
dc.contributor.authorDouglas, M.
dc.contributor.authorRaftery, M.
dc.date.accessioned2020-01-14T06:54:50Z
dc.date.available2020-01-14T06:54:50Z
dc.date.issued2020-01-09
dc.date.updated2020-01-12T04:43:31Z
dc.description.abstractAbstract Background Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance.
dc.identifier.apacitationFuller, G. W., Tucker, R., Starling, L., Falvey, E., Douglas, M., & Raftery, M. (2020). The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study. http://hdl.handle.net/11427/30725en_ZA
dc.identifier.chicagocitationFuller, G. W, R. Tucker, L. Starling, E. Falvey, M. Douglas, and M. Raftery "The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study." (2020) http://hdl.handle.net/11427/30725en_ZA
dc.identifier.citationSports Medicine - Open. 2020 Jan 09;6(1):2
dc.identifier.ris TY - Journal Article AU - Fuller, G. W AU - Tucker, R. AU - Starling, L. AU - Falvey, E. AU - Douglas, M. AU - Raftery, M. AB - Abstract Background Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance. DA - 2020-01-09 DB - OpenUCT DP - University of Cape Town KW - Concussion KW - Screening KW - Rugby KW - Diagnostic accuracy LK - https://open.uct.ac.za PY - 2020 T1 - The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study TI - The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study UR - http://hdl.handle.net/11427/30725 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s40798-019-0231-y
dc.identifier.urihttp://hdl.handle.net/11427/30725
dc.identifier.vancouvercitationFuller G W, Tucker R, Starling L, Falvey E, Douglas M, Raftery M. The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study. 2020; http://hdl.handle.net/11427/30725.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.subjectConcussion
dc.subjectScreening
dc.subjectRugby
dc.subjectDiagnostic accuracy
dc.titleThe performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study
dc.typeJournal Article
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