TitleThe sensitivity and specificity of clinical measures of sport concussion: three tests are better than one.
Publication TypeJournal Article
Year of Publication2016
AuthorsResch, JE, Brown, CN, Schmidt, J, Macciocchi, SN, Blueitt, D, C Cullum, M, Ferrara, MS
JournalBMJ Open Sport Exerc Med
Volume2
Issue1
Paginatione000012
Date Published2016
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.

DOI10.1136/bmjsem-2015-000012
Alternate JournalBMJ Open Sport Exerc Med
PubMed ID27900145
PubMed Central IDPMC5117030