Concussion Clinic

Baseline Concussion Testing

Baseline Concussion Testing – What does the current evidence say?
 
Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in the scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC.
 
The Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to determine cognitive recovery from concussion based on comparing post-injury scores to baseline scores. This model is based on the premise that ImPACT baseline test scores are a valid and reliable measure of optimal cognitive function at baseline.  Growing evidence suggests that this premise may not be accurate and research shows that athletes may be reliably performing at levels lower than their best effort would produce when taking the baseline test.
 
A recent study showed that a high rate of athletes had invalid and sandbagging scores which raised concern that the underperformance of baseline testing occurs more commonly than is probably realized.  Baseline testing may be useful in some cases but is not necessary, required, or an accepted standard of care for the appropriate management of SRC.  The findings suggest that incorporating baseline assessments does not significantly increase diagnostic yield for acute concussion. Computerized neurocognitive tests are used frequently in high school athletes, often within a model of baseline testing of asymptomatic individuals before the start of a sporting season. Current evidence suggests that in this population such testing may lack sufficient reliability to support clinical decision making. Furthermore, given the high and fluctuating test performance failure across validity indicators and cutoffs, the validity of baseline data has become a source of concern. Increased caution is called for in employing the baseline-to-postconcussion paradigm when return-to-play decisions are made.

 REFERENCES
  1. Higgins KL, Caze T, Maerlender A. Validity and Reliability of Baseline Testing in a Standardized Environment. Arch Clin Neuropsychol. 2018 Jun 1;33(4):437-443.
  2. Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane S, Kontos AP, Leddy JJ, McCrea MA, Poddar SK, Putukian M, Wilson JC, Roberts WO. American Medical Society for Sports Medicine Position Statement on Concussion in Sport. Clin J Sport Med. 2019 Mar;29(2):87-100
  3. Tsushima WT, Yamamoto MH, Ahn HJ, Siu AM, Choi SY, Murata NM. Invalid Baseline Testing with ImPACT: Does Sandbagging Occur with High School Athletes? Appl Neuropsychol Child. 2021 Jul-Sep;10(3):209-218.
  4. MacDonald J, Duerson D. Reliability of a Computerized Neurocognitive Test in Baseline Concussion Testing of High School Athletes. Clin J Sport Med. 2015 Jul;25(4):367-72.
  5. Abeare CA, Messa I, Zuccato BG, Merker B, Erdodi L. Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator. JAMA Neurol. 2018 Jun 1;75(6):697-703
  6. Ferris LM, Kontos AP, Eagle SR, Elbin RJ, Collins MW, Mucha A, McAllister TW, Broglio SP, McCrea M, Pasquina PF, Port NL. Utility of VOMS, SCAT3, and ImPACT Baseline Evaluations for Acute Concussion Identification in Collegiate Athletes: Findings From the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Am J Sports Med. 2022 Mar;50(4):1106-1119.

Save The Brain Concussion Management Program

If you suspect that your child sustained a concussion, they should be removed form play and they should see their Athletic trainer at their school.  If their school does not have an athletic trainer, they should see a provider at the concussion clinic.  Telemedicine appointments are available if you live outside our area. 
The concussion clinic is located at 205 Sunnyview Lane, Kalispell, MT, 59901.  406-758-7035.

For Athletic Training Staff information click HERE.

To go to Save The Brain's home page click HERE.

For further questions, email savethebrain@logan.org.

Concussion Clinic
Neuroscience and Spine Institute
Department of Physical Medicine & Rehab
205 Sunnyview Lane
Kalispell, MT 59901
Phone 406.758.7035
 
Concussion Testing
Phone 406.758-7323
savethebrain@logan.org
 
KRH Outpatient Therapy
Phone 406.751.4520
 
Athletic Training Staff
Youth Development   www.logan.org/youthdevelopment
For Athletic Training Staff information click HERE
 

Additional Resources

Centers for Disease Control (CDC):  https://www.cdc.gov/headsup/index.html
Brain Injury Association of America:  https://www.biausa.org/  
Brain Injury Alliance of Montana:  https://biamt.org/
Coffee With Survivors of Traumatic Brain Injury and Other Injuries
Saturdays at 10:00 am
Gateway Community Center
1203 US-2 
Kalispell, MT 59901

Don 406-871-2942
Brain Injury Helpline:  1-800-241-6442