Assessing the predictive value of primary evaluation with the Immediate Post-Concussion Assessment and Cognitive Test following head injury

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  • 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York;
  • 2 Physical Medicine and Rehabilitation, Concussion Management of New York, New York; and
  • 3 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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OBJECTIVE

Concussions are a major public health concern, especially for high school and college student athletes. However, there are few prognostic metrics that can accurately quantify concussion severity in order to anticipate recovery time and symptom regression. The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) is a widely used neurocognitive assessment that can diagnose and track recovery from concussions. This study assesses whether initial ImPACT scores, collected within 48 hours of the injury, can predict persistence of concussion at follow-up.

METHODS

Results from 6912 ImPACT tests were compiled in 2161 unique student athletes, ages 12–22 years. The authors defined a novel metric, the Severity Index (SI), which is a summation of the number of standard deviations from baseline at the 80% CI for each of the 5 composite scores reported by ImPACT. Patients were binned into groups based on SI (0–3.99, 4–7.99, 8–11.99, 12+) and the relationships between SI groups, composite scores, symptom profiles, and recovery time were characterized using 1-way and 2-way ANOVAs and Kaplan-Meier plots. A logistic regression assessed the value of SI for predicting concussion at follow-up.

RESULTS

Patients with a higher SI at diagnosis were more likely to still be concussed at their first follow-up (F3,2300 = 93.06; p < 0.0001). Groups with a higher SI also displayed consistently slower recovery over a 42-day period and were more likely to report symptoms in all 4 symptom clusters (Migraine, Cognition, Sleep, and Neuropsychiatric). When controlling for sex, age, number of previous concussions, days between assessments, and location, SI significantly increased the odds of being concussed at follow-up (OR 1.122, 95% CI 1.088–1.142; p < 0.001). This model showed good discrimination with an area under the curve of 0.74.

CONCLUSIONS

SI is a useful prognostic tool for assessing head injury severity. Concussions with higher initial SI tend to last longer and have broader symptomatic profiles. These findings can help patients and providers estimate recovery based on similar ImPACT score profiles.

ABBREVIATIONS AUC = area under the curve; ImPACT = Immediate Post-Concussion Assessment and Cognitive Test; PCSS = Post-Concussion Symptom Scale; PI1 = first postinjury test; PI2 = second postinjury test; Sdiff = standard error of difference at the 80% CI; SI = Severity Index; ΔScore = changes in composite scores.

Supplementary Materials

    • Tables and Figure S1–S4 (ZIP 1.04 MB)

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Contributor Notes

Correspondence Nickolas Dreher: Icahn School of Medicine at Mount Sinai, New York, NY. nickolas.dreher@icahn.mssm.edu.

INCLUDE WHEN CITING Published online May 8, 2020; DOI: 10.3171/2020.2.PEDS19709.

T.H. and N.D. contributed equally to this work.

Disclosures Dr. Lovell is the co-founder of ImPACT Applications, Inc.

  • 1

    Ianof JN, Freire FR, Calado VTG, Sport-related concussions. Dement Neuropsychol. 2014;8(1):1419.

  • 2

    Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375378.

    • Search Google Scholar
    • Export Citation
  • 3

    DePadilla L, Miller GF, Jones SE, Self-reported concussions from playing a sport or being physically active among high school students—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(24):682685.

    • Search Google Scholar
    • Export Citation
  • 4

    Terwilliger VK, Pratson L, Vaughan CG, Gioia GA. Additional post-concussion impact exposure may affect recovery in adolescent athletes. J Neurotrauma. 2016;33(8):761765.

    • Search Google Scholar
    • Export Citation
  • 5

    Iverson GL, Lovell MR, Collins MW. Interpreting change on ImPACT following sport concussion. Clin Neuropsychol. 2003;17(4):460467.

  • 6

    Lau BC, Collins MW, Lovell MR. Sensitivity and specificity of subacute computerized neurocognitive testing and symptom evaluation in predicting outcomes after sports-related concussion. Am J Sports Med. 2011;39(6):12091216.

    • Search Google Scholar
    • Export Citation
  • 7

    Schatz P, Pardini JE, Lovell MR, Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. Arch Clin Neuropsychol. 2006;21(1):9199.

    • Search Google Scholar
    • Export Citation
  • 8

    Fehr SD, Nelson LD, Scharer KR, Risk factors for prolonged symptoms of mild traumatic brain injury: a pediatric sports concussion clinic cohort. Clin J Sport Med. 2019;29(1):1117.

    • Search Google Scholar
    • Export Citation
  • 9

    Heyer GL, Schaffer CE, Rose SC, Specific factors influence postconcussion symptom duration among youth referred to a sports concussion clinic. J Pediatr. 2016;174:3338.e2.

    • Search Google Scholar
    • Export Citation
  • 10

    Miller JH, Gill C, Kuhn EN, Predictors of delayed recovery following pediatric sports-related concussion: a case-control study. J Neurosurg Pediatr. 2016;17(4):491496.

    • Search Google Scholar
    • Export Citation
  • 11

    Thomas DJ, Coxe K, Li H, Length of recovery from sports-related concussions in pediatric patients treated at concussion clinics. Clin J Sport Med. 2018;28(1):5663.

    • Search Google Scholar
    • Export Citation
  • 12

    Lau BC, Collins MW, Lovell MR. Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes. Neurosurgery. 2012;70(2):371379.

    • Search Google Scholar
    • Export Citation
  • 13

    Meehan WP III, Mannix RC, Stracciolini A, Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not. J Pediatr. 2013;163(3):721725.

    • Search Google Scholar
    • Export Citation
  • 14

    Teel EF, Marshall SW, Shankar V, Predicting recovery patterns after sport-related concussion. J Athl Train. 2017;52(3):288298.

  • 15

    Begasse de Dhaem O, Barr WB, Balcer LJ, Post-traumatic headache: the use of the Sport Concussion Assessment Tool (SCAT-3) as a predictor of post-concussion recovery. J Headache Pain. 2017;18(1):60.

    • Search Google Scholar
    • Export Citation
  • 16

    Hang B, Babcock L, Hornung R, Can computerized neuropsychological testing in the emergency department predict recovery for young athletes with concussions? Pediatr Emerg Care. 2015;31(10):688693.

    • Search Google Scholar
    • Export Citation
  • 17

    Resch JE, Brown CN, Macciocchi SN, A preliminary formula to predict timing of symptom resolution for collegiate athletes diagnosed with sport concussion. J Athl Train. 2015;50(12):12921298.

    • Search Google Scholar
    • Export Citation
  • 18

    McCrory P, Meeuwisse WH, Aubry M, Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250258.

    • Search Google Scholar
    • Export Citation
  • 19

    Wolf C, Fast K. “Put me back in, coach!” Concussion and return to play. Mo Med. 2017;114(1):3639.

  • 20

    Dessy AM, Yuk FJ, Maniya AY, Review of assessment scales for diagnosing and monitoring sports-related concussion. Cureus. 2017;9(12):e1922.

    • Search Google Scholar
    • Export Citation
  • 21

    Erlanger D, Kaushik T, Cantu R, Symptom-based assessment of the severity of a concussion. J Neurosurg. 2003;98(3):477484.

  • 22

    Iverson GL, Gardner AJ, Terry DP, Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941948.

    • Search Google Scholar
    • Export Citation

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