The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one

Abstract

Context: A battery of clinical measures of neurocognition, balance and symptoms has been recommended for the management of sport concussion (SC) but is based on variable evidence.

Objective: To examine the sensitivity and specificity of a battery of tests to assess SC in college athletes.

Design: Cross-sectional.

Setting: Research laboratory.

Patients or other participants: Division 1 athletes diagnosed with a SC (n=40) who were 20.2±1.60 years of age and 180.5±11.12 cm tall and healthy athletes (n=40) who were 19.0±0.93 years of age and 179.1±11.39 cm tall were enrolled.

Interventions: Participants were administered Immediate Postconcussion Assessment and Cognitive Test (ImPACT), the Sensory Organization Test (SOT) and the Revised Head Injury Scale (HIS-r) prior to and up to 24 h following injury between the 2004 and 2014 sport seasons. Sensitivity and specificity were calculated using predictive discriminant analyses (PDA) and clinical interpretation guidelines.

Main outcome measures: Outcome measures included baseline and postinjury ImPACT, SOT and HIS-r composite scores.

Results: Using PDA, each clinical measure's sensitivity ranged from 55.0% to 77.5% and specificity ranged from 52.5% to 100%. The test battery possessed a sensitivity and specificity of 80.0% and 100%, respectively. Using clinical interpretation guidelines, sensitivity ranged from 55% to 97.5% individually, and 100% when combined.

Conclusions: Our results support a multidimensional approach to assess SC in college athletes which correctly identified 80-100% of concussed participants as injured. When each test was evaluated separately, up to 47.5% of our sample was misclassified. Caution is warranted when using singular measures to manage SC.

Keywords: Concussion Assessment; Mild Traumatic Brain Injury; Neurocognitive; Sensitivity; Specificity.

Figure 1

The sensitivity of ImPACT, the SOT and HIS-r administered individually and combined. (A) Sensitivity as calculated using predictive discriminant analysis. (B) Sensitivity as calculated using clinical interpretation guidelines (ImPACT, Immediate Postconcussion Assessment and Cognitive Test).