TY - JOUR
T1 - Sensitivity and Specificity of the ImPACT Neurocognitive Test in Collegiate Athletes and US Military Service Academy Cadets with ADHD and/or LD
T2 - Findings from the NCAA-DoD CARE Consortium
AU - CARE Consortium Investigators
AU - Czerniak, Lauren L.
AU - Liebel, Spencer W.
AU - Zhou, Hannah
AU - Garcia, Gian Gabriel P.
AU - Lavieri, Mariel S.
AU - McCrea, Michael A.
AU - McAllister, Thomas W.
AU - Pasquina, Paul F.
AU - Broglio, Steven P.
AU - Benjamin, Holly J.
AU - Brooks, Alison
AU - Buckley, Thomas
AU - Cameron, Kenneth L.
AU - Clugston, James R.
AU - Duma, Stefan M.
AU - Eckner, James T.
AU - Estevez, Carlos
AU - Feigenbaum, Luis A.
AU - Giza, Christopher C.
AU - Goldman, Joshua T.
AU - Hoy, April
AU - Jackson, Jonathan C.
AU - Kaminski, Thomas W.
AU - Kelly, Louise A.
AU - Kontos, Anthony P.
AU - Master, Christina L.
AU - McDevitt, Jane
AU - Mihalik, Jason P.
AU - Miles, Christopher M.
AU - Ortega, Justus
AU - Port, Nicholas
AU - Putukian, Margot
AU - Schmidt, Julianne
AU - Susmarski, Adam
AU - Svoboda, Steven J.
N1 - Funding Information:
This publication was made possible in part by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 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 Combat Casualty Care Research Program, endorsed by the Department of Defense, through the Joint Program Committee 6/Combat Casualty Care Research Program—Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH1820047. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the DOD. The first author was supported by the Rackham Graduate School at the University of Michigan and the National Science Foundation Research Fellowship Program (Grant DGE 1841052). The third author was supported by the University of Michigan’s Summer Undergraduate Research in Engineering (SURE) Program.
Funding Information:
Alphabetically by last name, the CARE Consortium Investigators include: Holly J. Benjamin, MD, FACSM, FAMSSM, FAAP (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), James R. Clugston, MD, MS, FAMSSM (University of Florida; USA), Stefan M. Duma, PhD (Virginia Tech; USA), James T. Eckner, MD, MS (University of Michigan; USA), Carlos Estevez, DPT, OCS, ECS, FAAOMPT (United States Coast Guard Academy; USA), Luis A. Feigenbaum, PT, DPT, ATC/L (University of Miami; USA), Christopher C. Giza, MD (University of California, Los Angeles; USA), Joshua T. Goldman, MD, MBA (University of California, Los Angeles; USA), April Hoy, MS, ATC, CSCS (Azusa Pacific University; USA), Jonathan C. Jackson, MD (U.S. Air Force Academy; 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), Christina L. Master, MD, FAAP, CAQSM, FACSM (University of Pennsylvania; USA), Jane McDevitt, PhD, ATC, CSCS (Temple University; USA), Jason P. Mihalik, PhD, CAT(C), ATC, FACSM, FNATA (University of North Carolina at Chapel Hill; USA), Christopher M. Miles, MD, FAMSSM (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), Julianne Schmidt, PhD, ATC (University of Georgia; USA), Adam Susmarski, DO, FAAPMR (United States Naval Academy; USA), Steven J. Svoboda, MD, Colonel (retired), US Army (MedSTAR Orthopaedic Institute; USA). We thank Jody Harland, Susan Perkins, Barry Katz, 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), Stacey Harcum (Uniformed Services University), and the research and medical staff at each of the participating sites. We also thank Steve McMillan (editor of Sports Medicine) and two anonymous reviewers for the detailed and constructive feedback which improved the quality of the paper.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
PY - 2023/3
Y1 - 2023/3
N2 - Background and Objective: Computer-based neurocognitive tests are widely used in sport-related concussion management, but the performance of these tests is not well understood in the participant population with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD). This research estimates the sensitivity and specificity performance of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computer-based neurocognitive test in identifying concussion in this population. Methods: Study participants consisted of collegiate university athletes and military service academy cadets from the National Collegiate Athletic Association-Department of Defense CARE Consortium who completed the ImPACT test between 2014 and 2021. Participants who self-identified as belonging to one of the subgroups of interest (ADHD with or without LD [ADHD:LD+/−], LD with or without ADHD [LD:ADHD+/−], ADHD and/or LD [ADHD a/o LD]) and completed a baseline (1874 ADHD:LD+/−, 779 LD:ADHD+/−, 2338 ADHD a/o LD) or 24–48 h post-concussion (175 ADHD:LD+/−, 77 LD:ADHD+/−, 216 ADHD a/o LD) ImPACT assessment were included. Sensitivity and specificity were calculated using a normative data method and three machine learning classification methods: logistic regression, classification and regression tree, and random forest. Results: Using the four methods, participants with ADHD:LD+/− had sensitivities that ranged from 0.474 to 0.697, and specificities that ranged from 0.538 to 0.686. Participants with LD:ADHD+/− had sensitivities that ranged from 0.455 to 0.688, and specificities that ranged from 0.456 to 0.588. For participants with ADHD a/o LD, sensitivities ranged from 0.542 to 0.755, and specificities ranged from 0.451 to 0.724. Conclusions: For all subgroups and analytical methods, the results illustrate sensitivity and specificity values below typically accepted levels indicative of clinical utility. These findings support that using ImPACT alone may be insufficient to inform concussion diagnoses and encourages the use of a multi-dimensional concussion assessment.
AB - Background and Objective: Computer-based neurocognitive tests are widely used in sport-related concussion management, but the performance of these tests is not well understood in the participant population with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD). This research estimates the sensitivity and specificity performance of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computer-based neurocognitive test in identifying concussion in this population. Methods: Study participants consisted of collegiate university athletes and military service academy cadets from the National Collegiate Athletic Association-Department of Defense CARE Consortium who completed the ImPACT test between 2014 and 2021. Participants who self-identified as belonging to one of the subgroups of interest (ADHD with or without LD [ADHD:LD+/−], LD with or without ADHD [LD:ADHD+/−], ADHD and/or LD [ADHD a/o LD]) and completed a baseline (1874 ADHD:LD+/−, 779 LD:ADHD+/−, 2338 ADHD a/o LD) or 24–48 h post-concussion (175 ADHD:LD+/−, 77 LD:ADHD+/−, 216 ADHD a/o LD) ImPACT assessment were included. Sensitivity and specificity were calculated using a normative data method and three machine learning classification methods: logistic regression, classification and regression tree, and random forest. Results: Using the four methods, participants with ADHD:LD+/− had sensitivities that ranged from 0.474 to 0.697, and specificities that ranged from 0.538 to 0.686. Participants with LD:ADHD+/− had sensitivities that ranged from 0.455 to 0.688, and specificities that ranged from 0.456 to 0.588. For participants with ADHD a/o LD, sensitivities ranged from 0.542 to 0.755, and specificities ranged from 0.451 to 0.724. Conclusions: For all subgroups and analytical methods, the results illustrate sensitivity and specificity values below typically accepted levels indicative of clinical utility. These findings support that using ImPACT alone may be insufficient to inform concussion diagnoses and encourages the use of a multi-dimensional concussion assessment.
UR - http://www.scopus.com/inward/record.url?scp=85140043902&partnerID=8YFLogxK
U2 - 10.1007/s40279-022-01768-y
DO - 10.1007/s40279-022-01768-y
M3 - Article
C2 - 36239903
AN - SCOPUS:85140043902
SN - 0112-1642
VL - 53
SP - 747
EP - 759
JO - Sports Medicine
JF - Sports Medicine
IS - 3
ER -