Sport and Team Differences on Baseline Measures of Sport-Related Concussion

Context: With the advent of the National Collegiate Athletic Association's (NCAA's) mandating the presence and practice of concussion-management plans in collegiate athletic programs, institutions will consider potential approaches for concussion management, including both baseline and normative comparison approaches. Objective: To examine sport and team differences in baseline performance on a computer-based neurocognitive measure and 2 standard sideline measures of cognition and balance and to determine the potential effect of premorbid factors sex and height on baseline performance. Design: Cross-sectional study. Setting: University laboratory. Patients or Other Participants: A total of 437 NCAA Division II student-athletes (males = 273, females = 164; age = 19.61 +/- 1.64 years, height = 69.89 +/- 4.04 inches [177.52 +/- 10.26 cm]) were recruited during mandatory preseason testing conducted in a concussion-management program. Main Outcome Measure(s): The computerized Concussion Resolution Index (CRI), the Standardized Assessment of Concussion (Form A; SAC), and the Balance Error Scoring System (BESS). Results: Players on the men's basketball team tended to perform worse on the baseline measures, whereas soccer players tended to perform better. We found a difference in total BESS scores between these sports (P = .002). We saw a difference between sports on the hard-surface portion of the BESS (F-6,F-347 = 3.33, P = .003, eta(2)(p) = 0.05). No sport, team, or sex differences were found with SAC scores (P > .05). We noted differences between sports and teams in the CRI indices, with basketball, particularly the men's team, performing worse than soccer (P < .001) and softball/baseball (P = .03). When sex and height were considered as possible sources of variation in BESS and CRI team or sport differences, height was a covariate for the team (F-1,F-385 = 5.109, P = .02, eta(2)(p) = 0.013) and sport (F1,326 = 11.212, P = .001, eta(2)(p) = 0.033) analyses, but the interaction of sex and sport on CRI indices was not significant in any test (P > .05). Conclusions: Given that differences in neurocognitive functioning and performance among sports and teams exist, the comparison of posttraumatic and baseline assessment may lead to more accurate diagnoses of concussion and safer return-to- participation decision making than the use of normative comparisons.