Sensitivity and specificity of the online version of
ImPACT in high school and college athletes
ImPACT in high school and college athletes
Schatz P and Sandel
N. Am J Sports Med. 2012; 41(321):321-326.
N. Am J Sports Med. 2012; 41(321):321-326.
Take Home Message: The online version of the ImPACT test
is a valid test for the diagnosis of concussions in high school and college
athletes and may be effective for diagnosing suspected concussions when the
athlete did not report symptoms.
is a valid test for the diagnosis of concussions in high school and college
athletes and may be effective for diagnosing suspected concussions when the
athlete did not report symptoms.
Diagnosing
sports-related concussions can be challenging and various diagnostic tools have
been developed to identify sports-related concussions, including the Immediate
Post-Concussion Assessment and Cognitive Testing (ImPACT) tool. To date, the
online version of the ImPACT test has only undergone studies to determine the
test-retest reliability and rates of invalid baseline tests. Therefore, Schatz
and Sandel tested the sensitivity and specificity of the online version of
ImPACT using carefully matched samples of concussed and nonconcussed athletes.
The data was extracted by the lead programmer at ImPACT Applications, Inc. who
was blinded to the study’s hypothesis. Baseline and postconcussion data were
extracted for 81 athletes with symptomatic concussions, 37 athletes with
asymptomatic concussions (individuals suspected of having a concussion but who
did not report their symptoms), and 81 athletes with no concussion. All
athletes suspected of having a concussion were evaluated by either a certified
athletic trainer or team physician. Data from athletes with symptomatic
concussions were eligible for inclusion if the athlete: (a) was 13-21 years
old, (b) tested within 72 hours of sustaining a concussion, (c) did not report
attention deficit or hyperactivity disorder or learning disability, and (d)
spoke English. Data for athletes without a concussion were included if the
athlete met the criteria above except they had baseline testing at least 6
months after sustaining a concussion. The 81 athletes with concussion and
symptoms were matched to 81 athletes with no recent concussions based on sex,
age, handedness, sport, and history of concussion. Overall, the extracted data
yielded a sensitivity and specificity of 91.4% and 69.1% respectively, and a
positive and negative predictive values (the likelihood that a positive or
negative test correctly identifies the present condition) of 91.4% and 69.1%.
The online ImPACT test was also effective at identifying individuals suspected
of sustaining a concussion, reported being asymptomatic, and had an invalid
response pattern on the test (sensitivity = 97.3%, specificity = 97.3%; see
definitions below).
sports-related concussions can be challenging and various diagnostic tools have
been developed to identify sports-related concussions, including the Immediate
Post-Concussion Assessment and Cognitive Testing (ImPACT) tool. To date, the
online version of the ImPACT test has only undergone studies to determine the
test-retest reliability and rates of invalid baseline tests. Therefore, Schatz
and Sandel tested the sensitivity and specificity of the online version of
ImPACT using carefully matched samples of concussed and nonconcussed athletes.
The data was extracted by the lead programmer at ImPACT Applications, Inc. who
was blinded to the study’s hypothesis. Baseline and postconcussion data were
extracted for 81 athletes with symptomatic concussions, 37 athletes with
asymptomatic concussions (individuals suspected of having a concussion but who
did not report their symptoms), and 81 athletes with no concussion. All
athletes suspected of having a concussion were evaluated by either a certified
athletic trainer or team physician. Data from athletes with symptomatic
concussions were eligible for inclusion if the athlete: (a) was 13-21 years
old, (b) tested within 72 hours of sustaining a concussion, (c) did not report
attention deficit or hyperactivity disorder or learning disability, and (d)
spoke English. Data for athletes without a concussion were included if the
athlete met the criteria above except they had baseline testing at least 6
months after sustaining a concussion. The 81 athletes with concussion and
symptoms were matched to 81 athletes with no recent concussions based on sex,
age, handedness, sport, and history of concussion. Overall, the extracted data
yielded a sensitivity and specificity of 91.4% and 69.1% respectively, and a
positive and negative predictive values (the likelihood that a positive or
negative test correctly identifies the present condition) of 91.4% and 69.1%.
The online ImPACT test was also effective at identifying individuals suspected
of sustaining a concussion, reported being asymptomatic, and had an invalid
response pattern on the test (sensitivity = 97.3%, specificity = 97.3%; see
definitions below).
Overall, the results
indicate that the online ImPACT test is a valid test to diagnose acute
concussions in high school and collegiate athletes. Studies like these are
important because any time a test or outcome measure is modified it may change
how the test performs. In this case, it is reassuring that the online ImPACT
performs well. The probability that the test will detect a concussion if one is
present (sensitivity) was 91.4%, and the probability that the test will be
negative when no concussion is present (specificity) was 69.1%. Further, the online ImPACT test detected a
concussion even among athletes suspected of a concussion but did not report
symptoms. In fact, the authors found that the test may perform better among the
asymptomatic group and suggested that by “attempting to hide symptoms of
concussion, or otherwise ‘look good’ on testing, these athletes displayed more
variable behavior and paradoxically distinguished themselves” from the healthy
controls. This is critical to clinicians because as education about concussions
(and exposure to more professionals with diagnostic capability) increases, so
too does the athlete’s capability of withholding the presence of symptoms,
which would allow them to be prematurely cleared to return to sport. This could
result in a dangerous situation; however in these cases, the online version of
the ImPACT test may be an important tool to correctly identify concussions,
even in non-candid athletes. Tell us what you think. Do you currently use the
online version of the ImPACT test or another tool? If another tool is used,
what went into your decision to use that tool over the ImPACT test?
indicate that the online ImPACT test is a valid test to diagnose acute
concussions in high school and collegiate athletes. Studies like these are
important because any time a test or outcome measure is modified it may change
how the test performs. In this case, it is reassuring that the online ImPACT
performs well. The probability that the test will detect a concussion if one is
present (sensitivity) was 91.4%, and the probability that the test will be
negative when no concussion is present (specificity) was 69.1%. Further, the online ImPACT test detected a
concussion even among athletes suspected of a concussion but did not report
symptoms. In fact, the authors found that the test may perform better among the
asymptomatic group and suggested that by “attempting to hide symptoms of
concussion, or otherwise ‘look good’ on testing, these athletes displayed more
variable behavior and paradoxically distinguished themselves” from the healthy
controls. This is critical to clinicians because as education about concussions
(and exposure to more professionals with diagnostic capability) increases, so
too does the athlete’s capability of withholding the presence of symptoms,
which would allow them to be prematurely cleared to return to sport. This could
result in a dangerous situation; however in these cases, the online version of
the ImPACT test may be an important tool to correctly identify concussions,
even in non-candid athletes. Tell us what you think. Do you currently use the
online version of the ImPACT test or another tool? If another tool is used,
what went into your decision to use that tool over the ImPACT test?
Written by: Kyle
Harris
Harris
Reviewed by: Jeffrey
Driban
Driban
Related Posts:
Reliability of the Online Version of ImPACT in High School Athletes
Predicting the Persistence of Concussion-Related Impairments
Baseline Neurocognitive Test Performance and Symptoms may be Influenced by Depression
Balance and Neurocognitive Deficits in Non-Concussed Athletes
Reliability of the Online Version of ImPACT in High School Athletes
Predicting the Persistence of Concussion-Related Impairments
Baseline Neurocognitive Test Performance and Symptoms may be Influenced by Depression
Balance and Neurocognitive Deficits in Non-Concussed Athletes
Schatz P, & Sandel N (2013). Sensitivity and specificity of the online version of ImPACT in high school and collegiate athletes. The American Journal of Sports Medicine, 41 (2), 321-6 PMID: 23144368
Specificity rules in, sensitivity rules out. This can be remembered by SPin and SNout. For a great resource:
Loong. Understanding sensitivity and specificity with the right side of the brain. BMJ 2003;327;716-719.
That would make this test a good test for ruling out concussions but not great on ruling in concussions except in those individuals with suspected concussions that are not reporting symptoms (the test is good at ruling in and ruling out).