Performance of current tools used for on-the-day assessment and diagnosis of mild traumatic brain injury in sport: a systematic review.

OBJECTIVE: The monitoring and diagnosis of sports-related mild traumatic brain injury (SR-mTBI) remains a challenge. This systematic review summarises the current monitoring tools used for on-the-day assessment and diagnosis of SR-mTBI and their performance. DESIGN: Systematic review, using Quality Assessment of Diagnostic Accuracy Studies assessment. DATA SOURCES: Embase via Ovid, IEEEXplore, Medline via Ovid, Scopus and Web of Science were searched up to June 2024. ELIGIBILITY CRITERIA: Peer-reviewed English-language journal articles which measured athletes using the index test within a day of injury and provided a performance measure for the method used. Studies of all designs were accepted, and no reference methods were required. RESULTS: 2534 unique records were retrieved, with 52 reports included in the review. Participants were 76% male, when reported, and the mean injury-to-measurement time was reported in 10% of reports. 46 different methods were investigated. 38 different reference methods were used, highlighting the lack of gold standard within the field. Area under the curve (AUC), sensitivity and specificity were the most frequent outcome metrics provided. The most frequent index test was the King-Devick (KD) test. However, there were large variations in accuracy metrics between reports for the KD test, for instance, the range of AUC: 0.51-0.92. CONCLUSION: Combinations of existing methods and the KD test were most accurate in assessing SR-mTBI, despite the inconsistent accuracy values related to the KD test. The absence of a gold-standard measurement hampers our ability to diagnose or monitor SR-mTBI. Further exploration of the mechanisms and time-dependent pathophysiology of SR-mTBI could result in more targeted diagnostic and monitoring techniques. The Podium Institute for Sports Medicine and Technology funded this work. PROSPERO REGISTRATION NUMBER: CRD42022376560.