TY - JOUR
T1 - Sensitivity and Specificity of Computer-Based Neurocognitive Tests in Sport-Related Concussion
T2 - Findings from the NCAA-DoD CARE Consortium
AU - CARE Consortium Investigators
AU - Czerniak, Lauren L.
AU - Liebel, Spencer W.
AU - Garcia, Gian Gabriel P.
AU - Lavieri, Mariel S.
AU - McCrea, Michael A.
AU - McAllister, Thomas W.
AU - Broglio, Steven P.
AU - Anderson, Scott A.
AU - Benjamin, Holly J.
AU - Brooks, Alison
AU - Buckley, Thomas
AU - Cameron, Kenneth L.
AU - Chrisman, Sara P.D.
AU - Clugston, James R.
AU - Duma, Stefan M.
AU - Eckner, James
AU - Feigenbaum, Luis A.
AU - Goldman, Joshua T.
AU - Hazzard, Joseph B.
AU - Houston, Megan N.
AU - Hoy, April
AU - Kaminski, Thomas W.
AU - Kelly, Louise A.
AU - Kontos, Anthony P.
AU - Lintner, Laura
AU - Master, Christina L.
AU - McDevitt, Jane
AU - McGinty, Gerald
AU - Miles, Jessica Dysart
AU - Miles, Chris
AU - Ortega, Justus
AU - Port, Nicholas
AU - Putukian, Margot
AU - Rowson, Steve
AU - Schmidt, Julianne
AU - Stitzel, Joel D.
AU - Susmarski, Adam James
AU - Whitlow, Christopher T.
N1 - Funding Information:
This publication was made possible, in part, by support from the Grand Alliance CARE Consortium, funded by the NCAA and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014, USA, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14-2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).
Funding Information:
Alphabetically by last name, the CARE Consortium investigators include: Scott A. Anderson, ATC (University of Oklahoma, USA); Holly J. Benjamin, MD, FAAP, FACSM (University of Chicago, USA); Alison Brooks, MD, MPH (University of Wisconsin-Madison, USA); Thomas Buckley, EdD, ATC (University of Delaware, USA); Kenneth L. Cameron, PhD, MPH, ATC, FNATA (United States Military Academy, USA); Sara PD Chrisman, MD, MPH (University of Washington, USA); James R. Clugston, MD, MS, CAQSM (University of Florida, USA); Stefan M. Duma, PhD (Virginia Tech, USA); James Eckner, MD, MS (University of Michigan, USA); Luis A. Feigenbaum, PT, DPT, ATC/L (University of Miami, USA); Joshua T. Goldman, MD, MBA (University of California, Los Angeles, USA); Joseph B. Hazzard Jr., ATC (Bloomsburg University, USA); Megan N. Houston, PhD, ATC (United States Military Academy West Point, USA); April Hoy, MS, ATC, CSCS (Azusa Pacific University, USA); Thomas W. Kaminski, PhD, ATC, FNAK, FNATA, FACSM, RFSA (University of Delaware, USA); Louise A. Kelly, PhD (California Lutheran University, USA); Anthony P. Kontos, PhD (University of Pittsburgh, USA); Laura Lintner, DO (Wake Forest University School of Medicine, USA); Christina L. Master, MD, FAAP, CAQSM, FACSM (University of Pennsylvania, USA); Jane McDevitt, PhD, LAT, ATC, CSCS (Temple University, USA); Gerald McGinty, PT, DPT (United States Air Force Academy, USA); Jessica Dysart Miles, LAT, ATC (University of North Georgia, USA); Chris Miles, MD (Wake Forest University, USA); Justus Ortega, PhD (Humboldt State University, USA); Nicholas Port, PhD (Indiana University, USA); Margot Putukian, MD, FACSM, FAMSSM (Princeton University, USA); Steve Rowson, PhD (Virginia Tech, USA); Julianne Schmidt, PhD, ATC (University of Georgia, USA); Joel D. Stitzel, PhD (Wake Forest University, USA); Adam James Susmarski, DO, CDR, MC, USN (United States Naval Academy, USA); Christopher T. Whitlow, MD, PhD, MHA (Wake Forest University, USA). We would also like to thank Jody Harland, Janetta Matesan, and Larry Riggen (Indiana University), Ashley Rettmann, Nicole L'Heureux (University of Michigan), Melissa Koschnitzke (Medical College of Wisconsin), Michael Jarrett, Vibeke Brinck, and Bianca Byrne (Quesgen), Thomas Dompier, Christy Collins, Melissa Niceley Baker, and Sara Dalton (Datalys Center for Sports Injury Research and Prevention), and the research and medical staff at each of the participating sites.
Funding Information:
Lauren L. Czerniak, Spencer W. Liebel, Gian-Gabriel P. Garcia, and Mariel S. Lavieri have no competing interests directly relevant to the content of this study. Michael A. McCrea, Thomas W. McAllister, and Steven P. Broglio received research support from the NCAA and the U.S. Department of Defense.
Publisher Copyright:
© 2020, Springer Nature Switzerland AG.
PY - 2021/2
Y1 - 2021/2
N2 - Background: To optimally care for concussed individuals, a multi-dimensional approach is critical and a key component of this assessment in the athletic environment is computer-based neurocognitive testing. However, there continues to be concerns about the reliability and validity of these testing tools. The purpose of this study was to determine the sensitivity and specificity of three common computer-based neurocognitive tests (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], CNS Vital Signs, and CogState Computerized Assessment Tool [CCAT]), to provide guidance on their clinical utility. Methods: This study analyzed assessments from a cohort of collegiate athletes and non-varsity cadets from the NCAA-DoD CARE Consortium. The data were collected from 2014–2018. Study participants were divided into two testing groups [concussed, n = 1414 (baseline/24–48 h) and healthy, n = 8305 (baseline/baseline)]. For each test type, change scores were calculated for the components of interest. Then, the Normative Change method, which used normative data published in a similar cohort, and the Reliable Change Index (RCI) method were used to determine if the change scores were significant. Results: Using the Normative Change method, ImPACT performed best with an 87.5%-confidence interval and 1 number of components failed (NCF; sensitivity = 0.583, specificity = 0.625, F1 = 0.308). CNS Vital Signs performed best with a 90%-confidence interval and 1 NCF (sensitivity = 0.587, specificity = 0.532, F1 = 0.314). CCAT performed best when using a 75%-confidence interval and 2 NCF (sensitivity = 0.513, specificity = 0.715, F1 = 0.290). When using the RCI method, ImPACT performed best with an 87.5%-confidence interval and 1 NCF (sensitivity = 0.626, specificity = 0.559, F1 = 0.297). Conclusion: When considering all three computer-based neurocognitive tests, the overall low sensitivity and specificity results provide additional evidence for the use of a multi-dimensional assessment for concussion diagnosis, including symptom evaluation, postural control assessment, neuropsychological status, and other functional assessments.
AB - Background: To optimally care for concussed individuals, a multi-dimensional approach is critical and a key component of this assessment in the athletic environment is computer-based neurocognitive testing. However, there continues to be concerns about the reliability and validity of these testing tools. The purpose of this study was to determine the sensitivity and specificity of three common computer-based neurocognitive tests (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], CNS Vital Signs, and CogState Computerized Assessment Tool [CCAT]), to provide guidance on their clinical utility. Methods: This study analyzed assessments from a cohort of collegiate athletes and non-varsity cadets from the NCAA-DoD CARE Consortium. The data were collected from 2014–2018. Study participants were divided into two testing groups [concussed, n = 1414 (baseline/24–48 h) and healthy, n = 8305 (baseline/baseline)]. For each test type, change scores were calculated for the components of interest. Then, the Normative Change method, which used normative data published in a similar cohort, and the Reliable Change Index (RCI) method were used to determine if the change scores were significant. Results: Using the Normative Change method, ImPACT performed best with an 87.5%-confidence interval and 1 number of components failed (NCF; sensitivity = 0.583, specificity = 0.625, F1 = 0.308). CNS Vital Signs performed best with a 90%-confidence interval and 1 NCF (sensitivity = 0.587, specificity = 0.532, F1 = 0.314). CCAT performed best when using a 75%-confidence interval and 2 NCF (sensitivity = 0.513, specificity = 0.715, F1 = 0.290). When using the RCI method, ImPACT performed best with an 87.5%-confidence interval and 1 NCF (sensitivity = 0.626, specificity = 0.559, F1 = 0.297). Conclusion: When considering all three computer-based neurocognitive tests, the overall low sensitivity and specificity results provide additional evidence for the use of a multi-dimensional assessment for concussion diagnosis, including symptom evaluation, postural control assessment, neuropsychological status, and other functional assessments.
UR - http://www.scopus.com/inward/record.url?scp=85098480229&partnerID=8YFLogxK
U2 - 10.1007/s40279-020-01393-7
DO - 10.1007/s40279-020-01393-7
M3 - Article
C2 - 33315231
AN - SCOPUS:85098480229
SN - 0112-1642
VL - 51
SP - 351
EP - 365
JO - Sports Medicine
JF - Sports Medicine
IS - 2
ER -