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CARE Consortium: Concussion test-retest reliability

Research paper explores viability of concussion assessment tools

Steven Broglio, director of Michigan’s NeuroTrauma Research Laboratory, and principal investigators from the 30 Concussion Assessment, Research and Education Consortium institutions examined the performance of commonly used concussion assessment tools in a November 2017 paper published in Sports Medicine. They used data gathered from 4,874 college athletes who participated in the CARE Consortium study and completed two or more annual baseline cognitive assessments.  

What did the study find?

Commonly used and emerging concussion assessment tools — such as ImPACT, the Standardized Assessment of Concussion, and the Balance Error Scoring System — do not meet the accepted reliability thresholds for clinical interpretation. This finding suggests that more testing (that is, repeated annual baseline concussion testing) may not yield more accurate diagnoses, as each subsequent test may not provide useful information beyond the first evaluation.

What are the implications?

Despite the tests not meeting clinical standards, the paper’s authors do not recommend abandoning their use altogether given the added value over solely self-report metrics. Because a more reliable concussion evaluation has yet to be developed, they recommend continued use with a focus on further refinement. “It’s not entirely clear yet how these findings will impact clinical care,” Broglio said. “We need to understand how sensitive and specific these measures are and then balance that against what we have available for clinical use.”

What’s next?

As researchers work to sharpen these widely used evaluation tools, they also will seek the most effective way to use them in combination. Though further study may reveal that baseline evaluations and follow-up tests like these require a substantive overhaul. “If we are able to show a single test or a number of tests in combination can provide high sensitivity and specificity to concussion, then we can continue with how we practice,” Broglio said. “If none of these measures work alone or in combination, then it may be time to rethink all of the measures we use.”