Sep 14, 2017
The Cutting Edge for Concussion Assessment


In October 2016, the leading experts on concussion in sports held their international conference in Berlin. One of the results was the latest version of the Sport Concussion Assessment Tool. Better known as SCAT5, it is designed to be used by physicians and other healthcare professionals to evaluate possible concussion in athletes ages 13 and over. A separate tool for younger children, known Child SCAT5 is also available.

Major changes made in SCAT5 include adding an unsure diagnosis at the conclusion of a post-injury exam and increasing the word recall test from five words to 10. This will increase its sensitivity, which dovetails nicely with the mission of the Integrated Concussion Evaluation (ICE) app from X2 Biosystems, which has been updated to include the new testing protocol.

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ICE was designed specifically to simplify the administration of Baseline, Post-Injury, and Return-to-Play assessments. The user interface is friendly and intuitive, utilizing touchscreen functionality to allow easy navigation of rosters and within assessments. The app includes many tools that simplify and standardize the execution of exams, making for a consistent implementation across examiners. One of the goals of standardization is to enable the aggregation of de-identified data for use in normalization efforts. Some examples of the tools provided are built-in timers, error counters, and cadence tools to insure consistency across examiners. It also has translated the self-assessment portion of the exam into many common languages.

While the software has been updated to the new protocol, the interface remains the same. “For any past and current users of ICE, the changes are not major,” says Brian Flaim of X2 Biosystems. “No changes were made to the general functionality of the app itself, and the assessments have maintained the same streamlined, user-friendly interface as in the past. Major improvements have been made in the performance of the app, which tended to have long sync times when large numbers of exams were being updated from cloud to device. The performance improvements have taken sync times down from minutes to seconds in most cases, and we are very proud of the optimizations we have made.”

Flaim says the ICE app offers users several advantages over pen-and-paper assessment systems. These include not having to lug around binders full of baseline assessments or sift through stacks of paper. The app also provides easy side-by-side comparisons of test results, and records can be securely emailed to a physician from within the app.

However, the app does not need Internet access to function, making it a perfect solution for facilities without steady wifi access. “Unlike most competitors, ICE is a true mobile sideline evaluation tool and does not require an active Internet connection for use,” Flaim says. “Athletic trainers can take their device anywhere they would like to conduct exams, whether it be an away game, a field far from the office, or the basement of a facility with no real connectivity. All assessment data is stored locally on the iPad and will sync with the cloud upon reacquiring Internet connectivity.”

In addition to its standard features, ICE can be tailored to fit specific needs. “Exams can be customized for individual organizations, so if someone wanted to change the Maddox questions to be specific to a sport, we can easily do that,” Flaim says. “We can also take entire modules out or add custom modules to collect data not included in the standard SCAT.”

ICE is used by a wide range of sports organizations, including professional leagues, colleges, universities, and high schools. Additional clients include hospitals, clinics, governmental organizations, and research facilities.

Although ICE is currently available only on Apple devices like the iPad and iPhone, the company is working on a version that will work non-iOS devices, in addition to other enhancements. “We also plan to incorporate a self-service editor for exam modules, allowing athletics trainers and organizations to customize the content and flow of the assessments they use,” Flaim says. “Integrations with various electronic health records (EHR) systems, in addition to those already completed, are in the works as well.

“ICE may be more affordable than you think,” he adds. “We offer flexible yearly subscriptions, and don’t charge by the assessment, roster spot, or user.”


For more information about ICE, contact the company at [email protected] for a demo and a conversation about how ICE can help your concussion management process.

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