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.
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ABSTRACT: The neurocognitive testing of sports concussion for injury management and return-to-play decisions has long been considered the gold standard in evaluation of the injury. Computerized testing batteries are frequently employed, with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) being the most used of all the current testing platforms to evaluate concussion. ImPACT's clinical report yields four normed composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time) and another composite score that is not normed but is used as a validity measure (Impulse Control), as well as their corresponding subtest scores, which are not normed. The current study provides normative data on each of the subtests used to calculate the composite scores. Normative data are separated by gender for athletes aged 13 to 21 years old and are stratified by the norm age brackets already employed by the ImPACT. These norms may be helpful in the interpretation of the ImPACT clinical report and further delineation of areas of neurocognitive dysfunction.11/2014; DOI:10.1080/21622965.2014.911094
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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: BACKGROUND:Headache-related symptoms may be predictive of delayed recovery in student athletes after sport-related concussion.Purpose and HYPOTHESIS:To compare balance performance, cognitive function, and symptom recovery in concussed student athletes with no headache, those with posttraumatic headache, and those with characteristics of posttraumatic migraine following a sport-related concussion. It was hypothesized that those with posttraumatic migraine would take longer to recover on all clinical measures. STUDY DESIGN:Cohort study (prognosis); Level of evidence, 2. METHODS:A total of 296 student athletes who sustained sport-related concussions (migraine, 52; headache, 176; no headache, 68) were evaluated on measures of balance performance, cognition, and symptoms. Patients were categorized into posttraumatic migraine, posttraumatic headache, and no headache groups based on symptoms reported 1 day after injury. Serial testing was conducted with the Balance Error Scoring System, the Standardized Assessment of Concussion, and a graded symptom checklist to evaluate balance performance, cognition, and symptoms, respectively, at baseline, at the time of injury, after the event, and at days 1, 2, 3, 5, 7, and 90. RESULTS:Student athletes with posttraumatic migraine experienced greater symptom severity scores than did those with posttraumatic headache and no headache at the time of injury, after the event, and through day 7 (P < .001 for all). By day 7, symptom severity scores reported by patients with posttraumatic migraine still demonstrated deficits relative to baseline (Δ = 5.6 ± 1.2) compared with patients with headache (Δ = -0.8 ± 0.7) and those with no headache (Δ = -1.4 ± 1.1). Patients with headache experienced greater symptom severity scores than patients with no headache at the time of injury (P < .001), after the event (P < .001), and at day 1 (P < .001), day 2 (P = .005), and day 3 (P = .038). Much smaller differences were observed between the headache and no headache groups beyond day 3 (P > .05). There were no group differences on balance performance (P = .439) and cognitive testing (P = .200) over time. Female patients were 2.13 times more likely than males to report posttraumatic migraine characteristics after concussion. CONCLUSION:Posttraumatic migraine characteristics are related to prolonged symptom recovery after sport-related concussion. Clinicians should exercise caution in making decisions about return to participation for athletes with migraine-like symptoms given the increased short-term impairments and delayed symptom recovery we observed.The American Journal of Sports Medicine 05/2013; 41(7). DOI:10.1177/0363546513487982 · 4.70 Impact Factor