A - 27 Evaluating the Necessity of a Third Trial in Sway Baseline Concussion Assessments for High School Athletes

Abstract Purpose This study compared performance on Sway Screenings versus Two- and Three-Trial baseline Assessments in evaluating concussion symptomatology and functional outcomes among high school athletes, to determine whether a third trial is necessary. Method A retrospective analysis included 999 students who completed the One-Trial Screening and 1000 who completed the Full Three-Trial Assessment using Sway Balance Mobile Application. Functional outcome measures included Balance, Memory, Reaction Time, Impulse Control, and Inspection Time. To assess the necessity of a third trial, the average across the first Two Trials was calculated by averaging the first two trials of the Three-Trial Assessment. Data were stratified by gender and age, with ordered logistic regression used to assess relationships between age and test scores. Results The Three-Trial Assessment provided the most reliable results, but the Two-Trial Score significantly improved reliability over the Single-Trial Screening, suggesting a third trial may not always be necessary. Males exhibited more pronounced differences between screening types, particularly in balance and memory scores, stabilizing over multiple trials. Age-related improvements were more apparent in males, while female scores remained stable across age groups, indicating that two trials may be sufficient for reliable data. Conclusions While the Three-Trial Assessment remains the most comprehensive approach using Sway, the analysis suggests that two trials may be sufficient for reliable baseline assessments. Males benefited more from repeated trials, particularly in balance assessments, whereas females showed minimal improvements beyond two trials. These findings highlight the need for gender- and age-specific assessment methods in concussion management for youth athletes.