Updated ACRM Criteria Highly Sensitive for Detecting Mild TBI in Youth Athletes

The 2023 American Congress of Rehabilitation Medicine (ACRM) diagnostic criteria demonstrates high sensitivity for identifying mild traumatic brain injury (TBI) among high school athletes with sport-related concussion, according to study findings published in the Journal of Head Trauma Rehabilitation.

Concussion and mild TBI definitions have varied, and clinical diagnosis remains challenging due to the subjective nature of symptom reporting. To address this, the ACRM recently updated its diagnostic framework to incorporate both symptom- and examination-based criteria. Researchers conducted an observational cohort study examining the updated ACRM criteria, comparing outcomes between those classified as having a full vs suspected mild TBI.

The cohort included 181 athletes aged 14 to 18 years (mean [SD] age, 16.3 [1.3] years; 64.1% boys; 71.3% White) who presented to a specialty concussion clinic within 72 hours of injury between November 2017 and April 2022. All athletes were previously diagnosed with sports-related concussion using the 2017 Concussion in Sport Group definition. Under the new ACRM framework, a full mild TBI diagnosis required a mechanism of injury along with either a clinical sign (amnesia or loss of consciousness) or the combination of at least 2 acute symptoms and 1 positive clinical examination finding. Individuals with fewer qualifying features were classified as suspected mild TBI.

Improving both diagnostic accuracy and practical implementation may help ensure timely and targeted care for high school age athletes recovering from SRC.

Across the cohort, 63.0% (n=114) met the criteria for full mild TBI, while 37.0% (n=67) were classified as suspected mild TBI. Athletes classified with full mild TBI were more likely than those with suspected mild TBI to receive on-field evaluations by certified athletic trainers (48.7% vs 31.3%; P =.010). The full mild TBI group also had a higher initial symptom burden, with a median Post-Concussion Symptom Scale score of 24.0 (IQR, 11.0–38.0) compared with 19.0 (IQR, 7.0–30.0) in the suspected mild TBI group.

Despite these differences, the researchers found no significant variations in recovery timelines between athletes with full mild TBI and those with suspected mild TBI. Median days to return-to-learn (4.0 vs 3.0), symptom resolution (11.0 vs 12.5), and return-to-play (15.0 vs 14.5) were comparable. Subgroup analysis further showed that whether athletes met the full mild TBI definition based on clinical signs or symptom-and-exam combinations did not affect recovery duration.

The researchers concluded that the updated ACRM mild TBI criteria effectively identified all athletes in the sample, either as full or suspected cases, indicating strong diagnostic sensitivity across a spectrum of concussion presentations. Classification differences appeared to reflect whether all standardized clinical examinations were completed rather than substantive clinical variation.

This study’s limitations include its retrospective design, reliance on self-reported symptoms, absence of a non-concussed control group, and limited generalizability beyond specialty concussion clinic athletes.

“Improving both diagnostic accuracy and practical implementation may help ensure timely and targeted care for high school age athletes recovering from [sports-related concussion],” the study authors concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.