A comparison of sideline versus clinical cognitive test performance in collegiate athletes

Objective: To test whether performance on 5 cognitive tests administered in a controlled clinical environment differed compared with administration in an uncontrolled sideline environment. Additionally, we investigated the effect of testing environment order on the learning effect for each cognitive test. Design and Setting: Athletes were assessed on 2 test occasions (8 +/- 2 days apart), once in a sports medicine research laboratory and once on a lacrosse practice field site. Subjects: A total of 59 Division I collegiate student-athletes participated in this study, Measurements: Normative data were collected on 5 cognitive tests (Stroop Test, Trail-Making Test part A, Trail-Making Test part B, Wechsler Digit-Span Forward Test, and Digit-Span Backward Test). Results: An independent-samples t test for environment difference on test day 1 revealed no significant differences between tests performed in the controlled environment and those performed in the uncontrolled environment. A repeated-measures analysis of variance test revealed a significant learning effect for all 5 tests, as subjects tended to improve approximately 11 points on the Stroop Test, 3 seconds on the Trail-Making A Test, 7 seconds on the Trail-Making B Test, and 1 point each on the Wechsler Digit Span Forward and Backward Tests. A paired-samples t test using delta scores (first test minus second test), sorted by order of testing environment, revealed a significant difference for the Stroop Test, but not for the remaining cognitive tests. Conclusions: There appears to be no difference in cognitive testing performance completed in a controlled clinical environment versus that performed in an uncontrolled sideline environment. This finding suggests that clinicians can administer cognitive tests to athletes with mild head injuries in uncontrolled sideline environments and expect valid results. Thus, clinicians can more thoroughly evaluate mildly head-injured athletes during the most crucial period after injury so that a safe return-to-play decision can be based on quantifiable, objective data.