Cutoff Scores in Neurocognitive Testing and Symptom Clusters That Predict Protracted Recovery From Concussions in High School Athletes
ABSTRACT Many studies address diagnosing concussions, but few look at predicting prognosis. A previous discriminant function analysis showed that symptom clusters derived from the Post-Concussion Symptom Scale and Immediate Postconcussion Assessment and Cognitive Testing composite scores used together improved predictions of protracted recovery after a sports-related concussion.
To determine cutoff scores in neurocognitive and Post-Concussion Symptom Scale symptom cluster scores when classifying protracted recovery in concussed athletes.
108 male high school football athletes completed a computer-based neurocognitive test battery (Immediate Postconcussion Assessment and Cognitive Testing) within a median of 2 days after injury. Patients completed graded exertional protocols requiring athletes to be symptom free at rest and during increasing levels of activity and had recovery of neurocognitive scores before return to play. After return to play, athletes were classified as protracted recovery (>14 days, n = 58) or short-recovery (≤14 days, n = 50). Receiver-operating characteristic curves analyzed each of the neurocognitive (verbal, visual, processing speed, and reaction time) and symptom cluster (migraine, cognitive, sleep, and neuropsychiatric) scores.
Cutoffs for migraine cluster, cognitive cluster, visual memory, and processing speed were statistically significant. Cutoffs at 75%, 80%, and 85% sensitivity to predict protracted recovery for the migraine symptom cluster were 15 or greater, 18, 20; cognitive symptom cluster 18 or greater, 19, 22; visual memory 48 or less, 46, 44.5; and processing speed 24.5 or less, 23.46, 22.5, respectively. Eighty-percent sensitivity indicates that the corresponding cutoff correctly identify 80% of concussed athletes requiring protracted recovery.
Specific cutoffs may help to set numerical thresholds for clinicians to predict which concussed athletes will have a protracted recovery.
SourceAvailable from: Christopher D Murawski[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this paper is to discuss risk and prognostic factors for concussion outcomes, review comprehensive approaches to assessment, and describe a new method for conceptualizing treatment for sport-related concussion using clinical experience. Based on the current literature of sport-related concussion and clinical experience, an approach for conceptualizing concussion care using clinical trajectories and targeted treatments was developed. A comprehensive approach to assessment and targeted treatments for sport-related concussion was developed using specific clinical trajectories. Sport-related concussions are heterogeneous and require an individualized clinical approach. The use of a comprehensive approach for assessing specific clinical trajectories following a sport-related concussion will help clinicians better conceptualize this injury. Clinicians can then match targeted treatment pathways to specific clinical trajectories to accelerate safe return to play for athletes following a sport-related concussion. LEVEL OF EVIDENCE: V.Knee Surgery Sports Traumatology Arthroscopy 12/2013; DOI:10.1007/s00167-013-2791-6 · 2.84 Impact Factor
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ABSTRACT: Millions of concussions occur every year in the United States. The public interest in concussion has increased after a number of high-profile deaths in high school athletes from sports-related head trauma and in some professional athletes from chronic traumatic encephalopathy. One of the most active areas of research in sports medicine during the last decade has been the evaluation and management of concussion. In this second article of a two-part series, we provide an overview of the latest scientific advances in concussion research. This overview includes an update on the pathobiological changes that occur during concussion and the results of biomechanical studies. In addition, to aid the practicing clinician, we review the literature on proven and currently studied concussion risk factors, including a history of concussion, fatigue, and age. Genetic polymorphisms and biomarkers may provide risk-prediction capability, but at present the research remains inconclusive. Diffusion tensor imaging and functional magnetic resonance imaging are promising technologies that reveal more sophisticated data about the impact of concussion on the brain. We review the existing literature on the application of these neuroimaging modalities to sports concussion. An update from the Fourth International Conference on Concussion in Sport, with highlights of new recommendations, and the presentation of the third edition of the Sports Concussion Assessment Tool to evaluate acute concussion, concludes our review.Southern Medical Journal 02/2014; 107(2):126-135. DOI:10.1097/SMJ.0000000000000064 · 1.12 Impact Factor
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ABSTRACT: Purpose To determine if central axonal injury underlies vestibulopathy and ocular convergence insufficiency after mild traumatic brain injury (TBI) by using tract-based spatial statistics (TBSS) analysis of diffusion-tensor imaging (DTI). Materials and Methods The institutional review board approved this study, and the requirement to obtain informed consent was waived. Diffusion-tensor images were retrospectively reviewed in 30 patients with mild TBI and vestibular symptoms and 25 patients with mild TBI and ocular convergence insufficiency. Control subjects consisted of 39 patients with mild TBI without vestibular abnormalities and 17 patients with mild TBI and normal ocular convergence. Fractional anisotropy (FA) maps were generated as a measure of white matter integrity and were analyzed with TBSS regression analysis by using a general linear model. DTI abnormalities were correlated with symptom severity, neurocognitive test scores, and time to recovery with the Pearson correlation coefficient. Results Compared with control subjects, patients with mild TBI and vestibular symptoms had decreased neurocognitive test scores (P < .05) and FA values in the cerebellum and fusiform gyri (P < .05). Patients with ocular convergence insufficiency had diminished neurocognitive test scores (P < .05) and FA values in the right anterior thalamic radiation and right geniculate nucleus optic tracts (P < .0001). Cerebellar injury showed an inverse correlation with recovery time (R = -0.410, P = .02). Anterior thalamic radiation injury showed correlation with decreased processing speed (R = 0.402, P < .05). Conclusion DTI findings in patients with mild TBI and vestibulopathy support the hypothesis that posttraumatic vestibulopathy has a central axonal injury component. Peripheral vestibular structures were not assessed, and a superimposed peripheral contribution may exist. DTI evaluation of central vestibular structures may provide a diagnostic imaging tool in these patients and a quantitative biomarker to aid in prognosis. © RSNA, 2014.Radiology 04/2014; 272(1):132670. DOI:10.1148/radiol.14132670 · 6.21 Impact Factor