title: Gender and age predict outcomes of cognitive, balance and vision testing in a multidisciplinary concussion center.
abstract: OBJECTIVE
  This study examined components of the Sports Concussion Assessment Tool, 3rd Edition (SCAT3) and a vision-based test of rapid number naming (King-Devick [K-D]) to evaluate sports and non-sports concussion patients in an outpatient, multidisciplinary concussion center. While the Symptom Evaluation, Standardized Assessment of Concussion (SAC), modified Balance Error Scoring System (BESS), and K-D are used typically for sideline assessment, their use in an outpatient clinical setting following concussion has not been widely investigated.
  
  
  METHODS
  K-D, BESS, SAC, and SCAT3 Symptom Evaluation scores were analyzed for 206 patients who received concussion care at the Concussion Center at NYU Langone Medical Center. Patient age, gender, referral data, mechanism of injury, time between concussive event and first concussion center appointment, and the first specialty service to evaluate each patient were also analyzed.
  
  
  RESULTS
  In this cohort, Symptom Evaluation scores showed a higher severity and a greater number of symptoms to be associated with older age (r = 0.31, P = 0.002), female gender (P = 0.002, t-test), and longer time between the concussion event and first appointment at the concussion center (r = 0.34, P = 0.008). Performance measures of K-D and BESS also showed associations of worse scores with increasing patient age (r = 0.32-0.54, P ≤ 0.001), but were similar among males and females and across the spectrum of duration since the concussion event. Patients with greater Symptom Severity Scores also had the greatest numbers of referrals to specialty services in the concussion center (r = 0.33, P = 0.0008). Worse Immediate Memory scores on SAC testing correlated with slower K-D times, potentially implicating the dorsolateral prefrontal cortex as a commonly involved brain structure.
  
  
  CONCLUSIONS
  This study demonstrates a novel use of sideline concussion assessment tools for evaluation in the outpatient setting, and implicates age and gender as predictors of outcomes for these tests.
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: peter.benedict@nyumc.org.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Benedict
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: natali.baner@nyumc.org.
authors.forename: Natali V
authors.initials: NV
authors.lastname: Baner
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: george.harrold@nyumc.org.
authors.forename: G Kyle
authors.initials: GK
authors.lastname: Harrold
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: nicholasmoehringer@yahoo.com.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moehringer
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: lisena.hasanaj@nyumc.org.
authors.forename: Lisena
authors.initials: L
authors.lastname: Hasanaj
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: liliana.serrano2@nyumc.org.
authors.forename: Liliana P
authors.initials: LP
authors.lastname: Serrano
authors.affiliation: Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: mara.sproul@nyumc.org.
authors.forename: Mara
authors.initials: M
authors.lastname: Sproul
authors.affiliation: Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: geraldine.pagnotta@nyumc.org.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Pagnotta
authors.affiliation: Department of Orthopaedics/ Sports Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: dennis.cardone@nyumc.org.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Cardone
authors.affiliation: Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: steven.flanagan@nyumc.org.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Flanagan
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: janet.rucker@nyumc.org.
authors.forename: Janet
authors.initials: J
authors.lastname: Rucker
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: steven.galetta@nyumc.org.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Galetta
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: laura.balcer@nyumc.org.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Balcer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001924:Brain Concussion / Q000150:complications*; D002648:Child; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010045:Outpatients; D004856:Postural Balance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology*; D012720:Severity of Illness Index; D012737:Sex Factors; D013223:Statistics as Topic; D014786:Vision Disorders / Q000209:etiology*; D055815:Young Adult
keywords: Cognition; Concussion; King–Devick test; SCAT2; Saccades; Sports