Determining a Schedule for Serial Post-concussion Assessments: The Philadelphia Sports Concussion Program.

Catherine McKeever, MS. Drexel University
Tracey Covassin, MS. Temple University
Philip Schatz Ph.D. Saint Joseph's University, Eric Zillmer, Psy.D. Drexel University
Michael Sachs, Ph.D. Temple University


Abstract
Baseline neuropsychological testing has been universally recommended for comparison with post-concussion data, in order to track recovery and determine fitness to return to play for athletes and recreational sport participants. The hallmark Virginia football studies incorporated serial neuropsychological assessments at 2 hours, 48 hours, 1 week and 1 month post-injury, which allowed for the determination of the time when an athlete's concussion symptoms were resolved. Since that time, numerous post-concussion serial assessment schedules and measures have been employed. We reviewed the literature and compared select studies demonstrating various schedules of serial post-concussion assessment and test batteries: 43% of these studies assessed athletes within 1-2 hours, 57% within 24-48 hours, 29% at 3 days, 71% at 5 days, 57% at 7 days and 29% at 30 days post-concussion. The Symbol-Digit Modalities test, Trail-Making tests, COWAT, and HVLT were the most frequently employed measures, being used in 100%, 71%, 57% and 57% of the studies reviewed, respectively. While this diversity of test measures and assessment schedules has lent to increased understanding of post-concussion recovery patterns, these between-study differences obviate collaborative data sharing or cross-comparisons at specific time intervals. In developing the Philadelphia Sports Concussion Project, a multi-center study of high school and college athletes, we chose to schedule serial post-concussion assessments at: 12-24 hours, 3 days, 5 days, and 7 days post injury, with continued assessments at 10, 14, 21, and 28 days post injury for those athletes continuing to experience post concussion symptoms.



Table 1. Comparison of Post-concussion Assessment Schedules and Measures.
Schedule of Serial Post-Concussion Assessments
 HoursDays 
Study1-224-483571030Measures Used
NCAA- Multiple sports
(Echmendia, et al., 2001)
224--7-30c PC, d HVLT, f SDMT, g Stroop, h Trails, j VIGIL/W, k Dig. Span, l PSU, m COWAT
NCAA-Football
(Collins, et al., 1999)
1-357--d HVLT, h Trails, k Dig. Span, f SDMT, m COWAT, n Pegboard
NCAA-Football
(Barth, et al., 1989)
-24-5-10-e SDMT, h Trails, o PASAT
Prof. Hockey Players
(Echemendia, 2001)
-24-5b 7b --c PC, d HVLT, f SDMT, i Trails, l PSU, m COWAT, p BVMT-R
Prof. Football Players
(Lovell & Collins, 1998)
-24-5---d HVLT, f SDMT, h Trails, k Dig. Span, m COWAT, n Pegboard
Prof. Rugby Players
(McCrory, et al., 1997)
1--5---e SDMT, r Choice RT., r Memory, r Orientation
Prof. Rugby Players
(Hinton-Bayre, et al., 1999)
--3a -7a -35ae SDMT, q Digit Symbol, r Speed of Comprehension
Clarification:
a Athletes tested 1 to 3 days, 1-2weeks, 3-5 weeks post-concussion;
b Athletes tested 5 to 7 days post-concussion

Explanation of Test Abbreviations:
c Post-Concussion Checklist; d Post-Concussion Checklist; e Symbol Digit Modalities Test; f Symbol Digit Modalities Test (with incidental memory test); g Stroop Test; h Trail Making Test A&B; i Color Trail Making Test; j Continuous Performance Task; k Digit Span; l Penn State University Cancellation Task; m Controlled Oral Word Association Test; n Grooved Pegboard Test; o Paced Auditory Serial Addition Test; p Brief Visuospatial Motor Test-Revised; q Digit Symbol subtest of WAIS; r Unspecified

Adapted from McKeever, C. & Schatz, P. (2003). Current issues in the identification, assessment, and management of concussions in sports-related injuries. Applied Neuropsychology