Concussion Screening Evaluation: BESS vs. SWAY


AUTHORS: Jeremy Altman, Linda Ye, Zach Hatoum, Aurash Zarrinbakhsh, Aidan Neustadtl, Dave Milzman, MD

OBJECTIVE: The Balance Error Scoring System (BESS) is the current gold standard for evaluating balance, one of the best predictors for the need for concussion intervention. Sway, a new gyroscope based iPhone application, is being proposed as a more sensitive and objective test. Our study compares Sway to BESS to determine if there is equal efficacy.

RESULTS: There is a moderate to strong correlation between BESS and Sway scores. The results are significant (p<.001). The average score of 4.1 on BESS correlates to an average score of 77.1 on Sway. According to “Normative data for the balance error scoring system: Implications for brain injury evaluation” (G.L. Iverson, M.L. Kaarto, and M.S. Koehle), the 76-90th percentile of individuals ages 20-39 scored 4-6 on BESS.

CONCLUSION: Sway is equally, if not more, sensitive as BESS. Sway leaves little room for human error. Future studies can determine if use of this simple accurate test will improve diagnosis of G concussion in the ED.