Comparison Of Concussion Assessment Tools: Standardized Assessment Of Concussion (SAC) And Immediate Post Concussion Assessment And Cognitive Test (ImPACT)

Journal of Athletic Training.. 2009 May;


Littleton, A. C., K. A. Fiala, M. C. Thompson and D. M. Ritenour.



Context: Several concussion assessment tools are available for use by clinicians, ranging from standard paper-and-pencil tests to more novel computerized neurocognitive assessments. In a position statement released by the NATA, experts state that using multiple instruments provides clinicians with a comprehensive picture of an individual’s cognitive function. When multiple tools are used, it is important that they provide insight to different aspects of cognitive processing. Objective: To identify if a relationship between scores on the Standardized Assessment of Concussion (SAC) and the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) exists in collegiate athletes who had no prior exposure to either test. Design: A single group correlational study. Setting: Controlled laboratory setting. Participants: Thirty-two Division III Collegiate Men’s Lacrosse players (age=21±2 years) with no previous exposure to the SAC or ImPACT tests. Intervention: Subjects reported to the Athletic Training Room and completed the SAC test in a quiet office. Prior to data collection, test administrators underwent training to standardize procedures. After completion of all SAC testing, the subjects reported to a computer laboratory to take the ImPACT test. Subjects were given instructions before the test and were monitored throughout the test by a certified athletic trainer. Main Outcome Measures: The SAC is an oral test that includes questions dealing with orientation (S-OR), immediate memory (S-IM), concentration (S-C) and delayed recall (S-DR). The individual is given a score for each of the sections, as well as a SAC total score. The ImPACT is a computerized neurocognitive test for the assessment of concussion. The ImPACT software develops results for the test, including composite scores for verbal memory (I-VER), visual memory (I-VIS), visual motor speed (I-VMS), reaction time (I-RT), impulse control (I-IC), and total symptoms (ITS). After completion of both tests, the subjects’ scores were entered into SPSS 15.0 and analyzed using the significance level of 0.05. Pearson correlations were conducted between the SAC components and the ImPACT composite scores. In addition, multiple linear regressions were performed to evaluate how well the collection of the SAC components predicted each of the ImPACT composite scores. Results: Pearson correlations revealed three significant relationships between SAC components and ImPACT composite scores; S-DR and I-VER [r(32)=0.362, p=0.042], S-C and I-VMS [r(32)=0.563, p=0.001], S-C and I-RT [r(32)= -0.377, p=0.034]. According to multiple linear regression output, combinations of SAC components did not have the ability to predict ImPACT composite scores, p>0.05. Conclusions: Other than subtle similarities between the tests, this data suggests that the SAC and ImPACT provide unique contributions to the understanding of cognitive processes. Therefore, athletic trainers should consider using both the SAC and ImPACT tests.

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