Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools (CNTs): Reliability and Validity for the Assessment of Sport-Related Concussion

Abstract

Limited data exist comparing the performance of computerized neurocognitive tests (CNTs) for assessing sport-related concussion. We evaluated the reliability and validity of three CNTs—ANAM, Axon Sports/Cogstate Sport, and ImPACT—in a common sample. High school and collegiate athletes completed two CNTs each at baseline. Concussed (n = 165) and matched non-injured control (n = 166) subjects repeated testing within 24 hr and at 8, 15, and 45 days post-injury. Roughly a quarter of each CNT's indices had stability coefficients (M = 198 day interval) over .70. Group differences in performance were mostly moderate to large at 24 hr and small by day 8. The sensitivity of reliable change indices (RCIs) was best at 24 hr (67.8%, 60.3%, and 47.6% with one or more significant RCIs for ImPACT, Axon, and ANAM, respectively) but diminished to near the false positive rates thereafter. Across time, the CNTs' sensitivities were highest in those athletes who became asymptomatic within 1 day before neurocognitive testing but was similar to the tests' false positive rates when including athletes who became asymptomatic several days earlier. Test–retest reliability was similar among these three CNTs and below optimal standards for clinical use on many subtests. Analyses of group effect sizes, discrimination, and sensitivity and specificity suggested that the CNTs may add incrementally (beyond symptom scores) to the identification of clinical impairment within 24 hr of injury or within a short time period after symptom resolution but do not add significant value over symptom assessment later. The rapid clinical recovery course from concussion and modest stability probably jointly contribute to limited signal detection capabilities of neurocognitive tests outside a brief post-injury window.

Chronic differences in white matter integrity following sport‐related concussion as measured by diffusion MRI: 6‐Month follow‐up

“…Participants were recruited from Project Head to Head, a prospective study of clinical recovery from SRC funded by the U.S. Department of Defense that enrolled contact and collision sport athletes from nine high schools and four colleges in southeastern Wisconsin between August 2012 and November 2014 (see LaRoche, Nelson, Connelly, Walter, & McCrea, 2015; Nelson et al, 2016; Nelson, Pfaller, Rein, & McCrea, 2015). From this larger sample, 27 male football players who sustained concussions during the fall 2014 season (concussed group) underwent neuroimaging as part of the concurrent GE-NFL Head Health Challenge-I research effort in addition to the parent project’s standard clinical post-injury protocol.…”

Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients

“…ANAM and ImPACT have been described in more detail in publications from the sports arm of this study and are summarized more briefly here (Chin, Nelson, Barr, McCrory, & McCrea, 2016; Nelson, LaRoche, et al, 2016; Nelson, Pfaller, Rein, & McCrea, 2015). …”

Reliability and Validity of the Sport Concussion Assessment Tool–3 (SCAT3) in High School and Collegiate Athletes

“…41 Those participants who completed the SCAT3 at preseason testing (N = 2018) were included in the analyses of baseline data. Data from those athletes who were concussed during the study period (n = 166) and their noninjured controls (n = 164) were also included in the analyses.…”