David K. Brennan1,2, Jam J. Khojasteh1

1Oklahoma State University; 2University of Oklahoma School of Community Medicine

Given the dangers of second-impact syndrome after sustaining a Sports Related Concussion (SRC), team physicians must establish a sideline evaluation protocol that is reliable and considers the safety of the player against premature Return to Play (RTP). PURPOSE: This study examines the RTP predictive value of two dichotomous screening tests, 1) modified Balance Error Scoring System (mBESS) and 2) Maddocks Memory (MM). Both tests are part of the New South Wales Rugby League Head Injury Assessment (HIA) tool used to determine player RTP status after sustaining a head impact. METHODS: Sports physicians from 14 professional teams (18-20 year age group) completed a standardized HIA (n=107) for all players sustaining a head impact over the course of a 22 game season. Chi Square (2x2) analyses were performed for RTP, mBESS and MM. Predictive values, specificity and sensitivity were calculated for RTP, mBESS and MM. RESULTS: Symptom distribution revealed; confusion (41%), dazed (36%) balance (35%) and memory (32%) as the four most prevalent symptoms reported. Only 3.7 % of assessed players were positive for a structural neck or cervical injury. For mBESS, the positive predicted value (PPV) for removal from play was low at 34%, negative predictive values (NPV) was moderate at 62%. There was a moderate relationship between mBESS and SRC status, χ2(1) = 16.957, p <.001, ES = .398, sensitivity was low (0.34) while specificity was high (0.96). Similarly, for MM and RTP, the PPV was low at 32% and the NPV was moderate at 61%. There was a moderate relationship between MM and RTP status, χ2(1) = 15.452, p <.001, ES = .380, sensitivity was low (0.26) and specificity was high (0.96). CONCLUSION: Both mBESS and MM had low sensitivity, high specificity with regard to determining RTP status. There was a moderate and statistical significant association between a positive mBESS test, a positive MM test and removal from play. For SRC no single test should determine player RTP status. The mBESS used in this protocol is a subjective (non-instrumented) test and may be prone to type II error due to inherent inconsistent rater reliability.

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