title: Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population.
abstract: BACKGROUND
  Mild traumatic brain injury (mTBI) constitutes 75% of more than 1.5 million traumatic brain injuries annually. There exists no consensus on point-of-care screening for mTBI. The Military Acute Concussion Evaluation (MACE) is a quick and easy test used by the US Army to screen for mTBI; however, its utility in civilian trauma is unclear. It has two parts: a history section and the Standardized Assessment of Concussion (SAC) score (0-30) previously validated in sports injury. As a performance improvement project, our institution sought to evaluate the MACE as a concussion screening tool that could be used by housestaff in a general civilian trauma population.
  
  
  METHODS
  From June 2013 to May 2014, patients 18 years to 65 years old with suspected concussion were given the MACE within 72 hours of admission to our urban Level I trauma center. Patients with a positive head computed tomography were excluded. Demographic data and MACE scores were recorded in prospect. Concussion was defined as loss of consciousness and/or posttraumatic amnesia; concussed patients were compared with those nonconcussed. Sensitivity and specificity for each respective MACE score were used to plot a receiver operating characteristic (ROC) curve. An ROC curve area of 0.8 was set as the benchmark for a good screening test to distinguish concussion from nonconcussion.
  
  
  RESULTS
  There were 84 concussions and 30 nonconcussed patients. Both groups were similar; however, the concussion group had a lower mean MACE score than the nonconcussed patients. Data analysis demonstrated the sensitivity and specificity of a range of MACE scores used to generate an ROC curve area of only 0.65.
  
  
  CONCLUSIONS
  The MACE showed a lower mean score for individuals with concussion, defined by loss of consciousness and/or posttraumatic amnesia. However, the ROC curve area of 0.65 highly suggests that MACE alone would be a poor screening test for mTBI in a general civilian trauma population.
  
  
  METHODS
  Diagnostic study, level II.
authors.affiliation: From the Jacobi Medical Center /Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Stone
authors.forename: Saman
authors.initials: S
authors.lastname: Safadjou
authors.forename: Benjamin
authors.initials: B
authors.lastname: Farber
authors.forename: Nerissa
authors.initials: N
authors.lastname: Velazco
authors.forename: Jianliang
authors.initials: J
authors.lastname: Man
authors.forename: Srinivas H
authors.initials: SH
authors.lastname: Reddy
authors.forename: Roxanne
authors.initials: R
authors.lastname: Todor
authors.forename: Sheldon
authors.initials: S
authors.lastname: Teperman
mesh_terms: D000293:Adolescent; D000328:Adult; D000435:Alcoholic Intoxication / Q000453:epidemiology; D001924:Brain Concussion / Q000175:diagnosis*; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult