title: Evaluation of the standardized assessment of concussion in a pediatric emergency department.
abstract: OBJECTIVE
  The Standardized Assessment of Concussion (SAC) is a validated tool for identifying the effects of mild traumatic brain injury (mTBI). Previous research focused on sport-related sideline evaluation of adolescents and adults. Our goal was to evaluate performance of the SAC among subjects with and without head injury in a pediatric emergency department (ED).
  
  
  METHODS
  This was an observational study of children 6 to 18 years of age who presented to an ED with blunt head injury (case-patients) or minor extremity injury (controls). SAC and graded-symptom-checklist scores were compared. American Academy of Neurology concussion grades, presence of loss of consciousness and posttraumatic amnesia were also compared with SAC and graded-symptom-checklist scores among case-patients.
  
  
  RESULTS
  Three hundred forty-eight children were enrolled. SAC scores trended lower (greater cognitive deficits) for case-patients compared with controls but did not reach significance. Graded-symptom-checklist scores were significantly higher among case-patients. Presence of altered mental status magnified this effect. There was no correlation between SAC scores and other indicators of mTBI. There was a positive correlation between graded-symptom-checklist scores and posttraumatic amnesia and American Academy of Neurology concussion grade.
  
  
  CONCLUSIONS
  The graded symptom checklist reliably identified mTBI symptoms for all children aged 6 years and older. SAC scores tended to be lower for case-patients compared with controls but did not reach significance. Patients with altered mental status at the time of injury manifest an increased number and severity of symptoms. Additional research into strategies to identify cognitive deficits related to mTBI and classify mTBI severity in children is needed.
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, and Clinical Translational Research Center, Children's Hospital Denver, 13123 E 16th Ave, B-251, Aurora, CO 80045, USA. grubenhoff.joe@tchden.org
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Grubenhoff
authors.forename: Michael
authors.initials: M
authors.lastname: Kirkwood
authors.forename: Dexiang
authors.initials: D
authors.lastname: Gao
authors.forename: Sara
authors.initials: S
authors.lastname: Deakyne
authors.forename: Joe
authors.initials: J
authors.lastname: Wathen
mesh_terms: D000293:Adolescent; D000647:Amnesia / Q000175:diagnosis / Q000209:etiology; D001924:Brain Concussion / Q000150:complications / Q000175:diagnosis*; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014474:Unconsciousness / Q000209:etiology