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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Patients with a higher SI at diagnosis were more likely to still be concussed at their first follow-up (F<jats:sub>3,2300</jats:sub> = 93.06; p &lt; 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 &lt; 0.001). This model showed good discrimination with an area under the curve of 0.74.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>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.</jats:p></jats:sec>

Concussion Incidence and Recovery Among Youth Athletes With ADHD Taking Stimulant-Based Therapy

“…The ImPACT PCSS survey was used to calculate the symptom score composite, and the ImPACT neurocognitive tests were used to calculate verbal memory, visual memory, visual motor skills, and reaction time composites. 6 , 11 …”

Sex-Related Differences in the Incidence, Severity, and Recovery of Concussion in Adolescent Student-Athletes Between 2009 and 2019

“…The use of the SI may permit a more complete assessment of severity than previously possible because the SI can better delineate severity from recovery time while also predicting recovery. 22 This is the first study to use SI to quantify neurocognitive concussion severity in a prospective fashion, although multiple previous concussion studies have made severity estimations using only Symptom scores or using recovery length as a retrospective indicator. 4,23,27,45,50 These differences in method make comparisons between these previous studies and ours more suited to discussions of symptom clusters and recovery findings rather than severity.…”

“…The sum of all significant composite score differences standardized by their respective S diff is the SI. 22…”

“…The sum of all significant composite score differences standardized by their respective S diff is the SI. 22 Recovery was assessed using a survival analysis in which the event was defined as recovery from concussion. Recovery from concussion was defined as having 0 or 1 composite scores that remained significantly deviated from baseline at PI2 testing.…”

“…This study examines sex-related differences in concussion incidence and recovery after concussion in young athletes through use of the Severity Index (SI), a new prognostic tool for assessing head trauma and concussion severity based on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). 22 We hypothesized that female participants would demonstrate worse outcomes in all 3 domains. With a large cohort, consisting of 10 years of patient data across multiple sports, this study aims to advance our understanding of how the sex of the athlete affects concussion in young athletes.…”