Maddocks questions in sideline assessment of possible concussion

The Maddocks questions were developed as a tool for assessing possible concussion on the sports sideline (pitchside).

The SCAT3 (Sport Concussion Assessment Tool - 3rd edition (1)) includes the following modified Maddocks questions in the assessment of possible concussion. When asking the Maddocks questions then the questions should be preceded with the preface:

• "I am going to ask you a few questions, please listen carefully and give your best effort."
  
  
• the modified Maddocks questions are:
  
  
  • At what venue are we today?
    
    
  • Which half is it now?
    
    
  • Who scored last in this match?
    
    
  • What did you play last week?
    
    
  • Did your team win the last game?

The Maddocks questions are used as part of the clinical assessment of possible concussion on the sports sideline along with other assessments described in SCAT3.

From the original research paper (2) when Maddocks described the use of the questions in assessing possible concussion:

• likelihood that an athlete without a concussion will be correctly classified based on the athlete's score on the Maddocks questions (a measure of its "specificity") is high (an athlete will be correctly classified between 86 and 100% of the time)
• the sensitivity of the test is broad - likelihood that an athlete with concussion will be correctly identified through the use of the Maddocks questions (a measure of its "sensitivity") varies widely (32 to 75%)
• if an athlete answers all the Maddocks questions then the likelihood that he is suffering from concussion is low although the Maddocks questions only form part of the assessment that is SCAT3
  • false-negative rate (the percentage of athletes who answer all questions correctly but nevertheless are later found to have suffered a concussion) is low (0-11%), making the Maddocks questions a valuable part of the screening for concussion on the sports sideline
• however the false positive rate for the test is relatively high (an athlete not being able to answer one or more questions and not having concussion)
  • false-positive rate varies (29-68%)
    • this is why SCAT3 uses sideline screening tools such as the Maddocks questions in combination with other diagnostic tools

Reference:

• SCAT3. Br J Sports Med 2013;47:259
• Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med 1995;5(1):32-35.