{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:51:48Z","timestamp":1786125108837,"version":"build-2736575974"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2020,5,20]],"date-time":"2020-05-20T00:00:00Z","timestamp":1589932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>The Sport Concussion Assessment Tool (SCAT) could be improved by identifying critical subsets that maximize diagnostic accuracy and eliminate low information elements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To identify optimal SCAT subsets for acute concussion assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Using Concussion Assessment, Research, and Education (CARE) Consortium data, we compared student-athletes\u2019 and cadets\u2019 preinjury baselines (n\u00a0=\u00a02178) with postinjury assessments within 6 h (n\u00a0=\u00a01456) and 24 to 48 h (n\u00a0=\u00a02394) by considering demographics, symptoms, Standard Assessment of Concussion (SAC), and Balance Error Scoring System (BESS) scores. We divided data into training\/testing (60%\/40%) sets. Using training data, we integrated logistic regression with an engineering methodology\u2014mixed integer programming\u2014to optimize models with\u00a0\u22644, 8, 12, and 16 variables (Opt-k). We also created models including only raw scores (Opt-RS-k) and symptom, SAC, and BESS composite scores (summary scores). We evaluated models using testing data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>At &lt;6\u00a0h and 24 to 48\u00a0h, most Opt-k and Opt-RS-k models included the following symptoms: do not feel right, headache, dizziness, sensitivity to noise, and whether physical or mental activity worsens symptoms. Opt-k models included SAC concentration and delayed recall change scores. Opt-k models had lower Brier scores (BS) and greater area under the curve (AUC) (&lt;6 h: BS\u00a0=\u00a00.072-0.089, AUC\u00a0=\u00a00.95-0.96; 24-48 h: BS\u00a0=\u00a00.085-0.093, AUC\u00a0=\u00a00.94-0.95) than Opt-RS-k (&lt;6 h: BS\u00a0=\u00a00.082-0.087, AUC\u00a0=\u00a00.93-0.95; 24-48 h: BS\u00a0=\u00a00.095-0.099, AUC\u00a0=\u00a00.92-0.93) and summary score models (&lt;6 h: BS\u00a0=\u00a00.14, AUC\u00a0=\u00a00.89; 24-48 h: BS\u00a0=\u00a00.15, AUC\u00a0=\u00a00.87).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>We identified SCAT subsets that accurately assess acute concussion and improve administration time over the complete battery, highlighting the importance of eliminating \u201cnoisy\u201d elements. These findings can direct clinicians to the SCAT components that are most sensitive to acute concussion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyaa150","type":"journal-article","created":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T15:13:43Z","timestamp":1586358823000},"page":"971-981","source":"Crossref","is-referenced-by-count":26,"title":["Optimizing Components of the Sport Concussion Assessment Tool for Acute Concussion Assessment"],"prefix":"10.1227","volume":"87","author":[{"given":"Gian-Gabriel P","family":"Garcia","sequence":"first","affiliation":[{"name":"Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariel S","family":"Lavieri","sequence":"additional","affiliation":[{"name":"Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W","family":"McAllister","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"McCrea","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven P","family":"Broglio","sequence":"additional","affiliation":[{"name":"Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the CARE Consortium Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,11]]},"reference":[{"issue":"11","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","article-title":"Consensus statement on concussion in sport\u2014the 5th international conference on concussion in sport held in Berlin, October 2016","volume":"51","author":"McCrory","year":"2017","journal-title":"Br J Sports Med"},{"issue":"6","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1177\/0363546518757984","article-title":"Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes","volume":"46","author":"Asken","year":"2018","journal-title":"Am J Sports Med"},{"issue":"1","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1212\/CPJ.0000000000000061","article-title":"Clinical challenges in the diagnosis and assessment of sports-related concussion","volume":"5","author":"Makdissi","year":"2015","journal-title":"Neurol Clin Pract"},{"issue":"6","key":"bib4-20231011","first-page":"1552","article-title":"Sports concussion diagnosis and management","volume":"20","author":"Kutcher","year":"2014","journal-title":"Continuum (N Y)"},{"issue":"11","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1136\/bjsports-2016-097441","article-title":"What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review","volume":"51","author":"Patricios","year":"2017","journal-title":"Br J Sports Med"},{"issue":"5","key":"bib6-20231011","first-page":"1","article-title":"The Sport Concussion Assessment Tool 5th edition (SCAT5)","volume":"5","author":"Echemendia","year":"2017","journal-title":"Br J Sports Med"},{"issue":"1","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1136\/bjsports-2012-091480","article-title":"Sport concussion knowledge base, clinical practises and needs for continuing medical education: a survey of family physicians and cross-border comparison","volume":"47","author":"Lebrun","year":"2013","journal-title":"Br J Sports Med"},{"issue":"4","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2016.1.FOCUS15611","article-title":"The Sport Concussion Assessment Tool: a systematic review","volume":"40","author":"Yengo-Kahn","year":"2016","journal-title":"Neurosurg Focus"},{"issue":"5","key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1136\/bjsports-2013-092225","article-title":"Evidence-based approach to revising the SCAT2: introducing the SCAT3","volume":"47","author":"Guskiewicz","year":"2013","journal-title":"Br J Sports Med"},{"issue":"7","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1007\/s40279-018-0880-x","article-title":"Quantifying the value of multidimensional assessment models for acute concussion: an analysis of data from the NCAA-DoD care consortium","volume":"48","author":"Garcia","year":"2018","journal-title":"Sport Med"},{"issue":"1","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"e000012","DOI":"10.1136\/bmjsem-2015-000012","article-title":"The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one","volume":"2","author":"Resch","year":"2016","journal-title":"BMJ Open Sport Exerc Med"},{"issue":"9","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.1177\/0363546516648141","article-title":"Reliability and validity of the Sport Concussion Assessment Tool-3 (SCAT3) in high school and collegiate athletes","volume":"44","author":"Chin","year":"2016","journal-title":"Am J Sports Med"},{"issue":"5","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1136\/bjsports-2013-092158","article-title":"Onfield assessment of concussion in the adult athlete","volume":"47","author":"Putukian","year":"2013","journal-title":"Br J Sports Med"},{"issue":"7","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1007\/s40279-017-0707-1","article-title":"A national study on the effects of concussion in collegiate athletes and US military service academy members: the NCAA\u2013DoD Concussion Assessment, Research and Education (CARE) Consortium structure and methods","volume":"47","author":"Broglio","year":"2017","journal-title":"Sport Med"},{"issue":"Suppl 1","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1227\/NEU.0000000000000433","article-title":"Concussion guidelines step 1: systematic review of prevalent indicators","volume":"75","author":"Carney","year":"2014","journal-title":"Neurosurgery"},{"issue":"7","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1007\/s40279-018-0880-x","article-title":"Quantifying the value of multidimensional assessment models for acute concussion: an analysis of data from the NCAA-DoD care consortium","volume":"48","author":"Garcia","year":"2018","journal-title":"Sport Med"},{"issue":"10","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1089\/neu.2018.6098","article-title":"A data-driven approach to unlikely, possible, probable, and definite acute concussion assessment","volume":"36","author":"Garcia","year":"2019","journal-title":"J Neurotrauma"},{"issue":"3","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1177\/1536867X0400400301","article-title":"Multiple imputation of missing values","volume":"4","author":"Royston","year":"2004","journal-title":"Stata J"},{"issue":"19","key":"bib19-20231011","doi-asserted-by":"crossref","first-page":"2556","DOI":"10.1001\/jama.290.19.2556","article-title":"Acute effects and recovery time following concussions in collegiate football players","volume":"290","author":"McCrea","year":"2004","journal-title":"JAMA"},{"issue":"01","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1017\/S1355617705050083","article-title":"Standard regression-based methods for measuring recovery after sport-related concussion","volume":"11","author":"McCrea","year":"2005","journal-title":"J Int Neuropsychol Soc"},{"issue":"1","key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1017\/S1355617712000872","article-title":"Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes","volume":"19","author":"McCrea","year":"2013","journal-title":"J Int Neuropsychol Soc"},{"issue":"3","key":"bib22-20231011","first-page":"238","article-title":"Sex differences and the incidence of concussions among collegiate athletes","volume":"38","author":"Covassin","year":"2003","journal-title":"J Athl Train"},{"issue":"2","key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1227\/01.NEU.0000279972.95060.CB","article-title":"Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes","volume":"61","author":"Covassin","year":"2007","journal-title":"Neurosurgery"},{"issue":"5","key":"bib24-20231011","doi-asserted-by":"crossref","first-page":"856","DOI":"10.3171\/jns.2005.102.5.0856","article-title":"Sex differences in outcome following sports-related concussion","volume":"102","author":"Broshek","year":"2005","journal-title":"J Neurosurg"},{"issue":"6","key":"bib25-20231011","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1177\/0363546512444554","article-title":"The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion","volume":"40","author":"Covassin","year":"2012","journal-title":"Am J Sports Med"},{"issue":"1","key":"bib26-20231011","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1249\/JSR.0b013e3181caa89d","article-title":"At-risk populations in sports-related concussion","volume":"9","author":"Kutcher","year":"2010","journal-title":"Curr Sports Med Rep"},{"issue":"4","key":"bib27-20231011","first-page":"495","article-title":"Concussions among united states high school and collegiate athletes","volume":"42","author":"Gessel","year":"2007","journal-title":"J Athl Train"},{"issue":"2","key":"bib28-20231011","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/00001199-199804000-00005","article-title":"Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete","volume":"13","author":"McCrea","year":"1998","journal-title":"J Head Trauma Rehabil"},{"issue":"2","key":"bib29-20231011","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1123\/jsr.8.2.71","article-title":"Relationship between clinical and forceplate measures of postural stability","volume":"8","author":"Riemann","year":"1999","journal-title":"J Sport Rehabil"},{"issue":"3","key":"bib31-20231011","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s10589-016-9832-2","article-title":"Feature subset selection for logistic regression via mixed integer optimization","volume":"64","author":"Sato","year":"2016","journal-title":"Comput Optim Appl"},{"issue":"1","key":"bib32-20231011","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1287\/ited.2013.0115","article-title":"A survey of linear and mixed-integer optimization tutorials","volume":"14","author":"Newman","year":"2013","journal-title":"INFORMS Trans Educ"},{"issue":"2","key":"bib33-20231011","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1287\/ited.7.2.153","article-title":"Formulating integer linear programs: a rogues\u2019 gallery","volume":"7","author":"Brown","year":"2010","journal-title":"INFORMS Trans Educ"},{"issue":"2","key":"bib34-20231011","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1287\/opre.2015.1353","article-title":"Planning for HIV screening, testing, and care at the veterans health administration","volume":"63","author":"Deo","year":"2015","journal-title":"Oper Res"},{"issue":"3","key":"bib35-20231011","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1287\/opre.2017.1706","article-title":"Optimal M-switch surveillance policies for liver cancer in a hepatitis C-infected population","volume":"66","author":"Chen","year":"2018","journal-title":"Oper Res"},{"issue":"5","key":"bib36-20231011","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/poms.12842","article-title":"Analysis of mammography screening policies under resource constraints","volume":"27","author":"Cevik","year":"2018","journal-title":"Prod Oper Manag"},{"issue":"4","key":"bib37-20231011","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1287\/msom.1110.0371","article-title":"The effect of budgetary restrictions on breast cancer diagnostic decisions","volume":"14","author":"Ayvaci","year":"2012","journal-title":"Manuf Serv Oper Manag"},{"issue":"1-4","key":"bib38-20231011","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1023\/A:1022938707934","article-title":"Integer programming applied to intensity-modulated radiation therapy treatment planning","volume":"119","author":"Lee","year":"2003","journal-title":"Ann Oper Res"},{"issue":"2","key":"bib39-20231011","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1214\/15-AOS1388","article-title":"Best subset selection via a modern optimization lens","volume":"44","author":"Bertsimas","year":"2016","journal-title":"Ann Stat"},{"issue":"1","key":"bib40-20231011","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1287\/opre.2015.1436","article-title":"OR forum\u2014an algorithmic approach to linear regression","volume":"64","author":"Bertsimas","year":"2016","journal-title":"Oper Res"},{"issue":"1","key":"bib41-20231011","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/JSM.0000000000000102","article-title":"Prospective clinical assessment using SIdeline Concussion Assessment Tool-2 testing in the evaluation of sport-related concussion in college athletes","volume":"25","author":"Putukian","year":"2015","journal-title":"Clin J Sport Med"},{"issue":"11","key":"bib42-20231011","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1080\/02699052.2018.1484166","article-title":"Determining sensitivity and specificity of the Sport Concussion Assessment Tool 3 (SCAT3) components in university athletes","volume":"32","author":"Downey","year":"2018","journal-title":"Brain Inj"},{"issue":"3","key":"bib43-20231011","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1207\/s15324826an1303_4","article-title":"Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale","volume":"13","author":"Lovell","year":"2006","journal-title":"Appl Neuropsychol"},{"issue":"3","key":"bib44-20231011","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1093\/arclin\/acp025","article-title":"Concussion symptom inventory: an empirically derived scale for monitoring resolution of symptoms following sport-related concussion","volume":"24","author":"Randolph","year":"2009","journal-title":"Arch Clin Neuropsychol"},{"issue":"6","key":"bib45-20231011","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1542\/peds.2014-0158","article-title":"Duration and course of post-concussive symptoms","volume":"133","author":"Eisenberg","year":"2014","journal-title":"Pediatrics"},{"issue":"1","key":"bib46-20231011","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.csm.2010.09.005","article-title":"The acute symptoms of sport-related concussion: diagnosis and on-field management","volume":"30","author":"Putukian","year":"2011","journal-title":"Clin Sports Med"},{"issue":"8","key":"bib47-20231011","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.3109\/02699052.2014.904049","article-title":"Disclosure and non-disclosure of concussion and concussion symptoms in athletes: review and application of the socio-ecological framework","volume":"28","author":"Kerr","year":"2014","journal-title":"Brain Inj"},{"issue":"2","key":"bib48-20231011","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1136\/bjsm.2005.021832","article-title":"Converging evidence for the under-reporting of concussions in youth ice hockey","volume":"40","author":"Williamson","year":"2006","journal-title":"Br J Sports Med"},{"issue":"1","key":"bib49-20231011","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s12160-014-9636-5","article-title":"Norms, athletic identity, and concussion symptom under-reporting among male collegiate ice hockey players: a prospective cohort study","volume":"49","author":"Kroshus","year":"2015","journal-title":"Ann Behav Med"},{"issue":"9","key":"bib50-20231011","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1249\/MSS.0b013e318258a9fb","article-title":"Identifying impairments after concussion","volume":"44","author":"Schmidt","year":"2012","journal-title":"Med Sci Sport Exerc"},{"issue":"7","key":"bib51-20231011","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1080\/13854046.2012.721006","article-title":"The utility of post-concussion neuropsychological data in identifying cognitive change following sports-related MTBI in the absence of baseline data","volume":"26","author":"Echemendia","year":"2012","journal-title":"Clin Neuropsychol"},{"issue":"6","key":"bib52-20231011","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1249\/MSS.0000000000001540","article-title":"Efficacy of tandem gait to identify impaired postural control after concussion","volume":"50","author":"Oldham","year":"2018","journal-title":"Med Sci Sport Exerc"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/87\/5\/971\/33880562\/nyaa150.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyaa150","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:50:24Z","timestamp":1786121424000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyaa150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,20]]},"references-count":51,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyaa150","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,20]]}}}