Age and test setting affect
the prevalence of invalid baseline scores on neurocognitive tests

J.D., Scolaro Moser R., Schatz P. Am J Sports Med. 2014;42(2):479-484.

Take Home Message: Younger
athletes (10-12 year olds) have more invalid baseline ImPACT exams compared to
older athletes (13-18 year olds). This is most pronounced when younger athletes
are tested in large groups in a nonclinical setting.

us to assess cognitive function following a concussion we often rely on a valid
baseline test. Unfortunately, many factors may increase the risk of invalid
baseline tests (e.g., fatigue/lack of sleep, testing environment).  While we’ve seen that 4 to 11% of individuals
13 years or older have invalid baseline testing results we have no data among younger
athletes. Therefore, the authors reviewed previously collected baseline tests
to examine the prevalence of invalid baseline tests between younger and older
youth athletes that completed their testing in a small or large group test
setting. Five hundred and two athletes (10 to 18 years old; 85% male) who participated
in a nonscholastic sport completed the online version of ImPACT between 2010
and 2013. Most of the athletes participated in ice hockey (59%) or lacrosse
(28%). Two hundred and seven athletes completed their baseline testing in a
large group. The large group setting consisted of testing at an athletic
facility, where ~10 athletes were taking the exam with 2 trained administrators
present. Two hundred and ninety-five athletes completed baseline testing in a
small group setting at a neuropsychology center. The small group consisted of
testing with 1 to 3 athletes at a time with 3 trained administrators. The authors
found that younger athletes (10-12 years old) had a greater proportion of
invalid baseline tests (7%) compared with older athletes (13-18 years old; 2.7%
invalid). Younger athletes who tested in a large group were more likely to
provide an invalid test (12%) compared with younger athletes tested in a
smaller group (5%), older athletes in a larger group (3%), or older athletes in
a smaller group (3%).

authors suggest that an athlete younger than 13 years should be tested in a
smaller group environment under strict supervision to decrease the risk of an invalid
baseline test. This suggests that younger athletes may need more attention or supervision
and an environment with less distraction when they take their baseline test. The
higher rate of invalid test results among younger athletes may indicate that
they do not know the importance or the necessity of baseline testing.
Additionally, they may not be able to read and understand the instructions for
the exam, which would explain the higher rate of invalid tests compared with older
athletes. It was interesting to note that the group setting did not influence
the rate of invalid baseline tests among athletes older than 13 years. This
indicates that a larger group setting may be reasonable for older athletes as
long as the administrators maintain a well-supervised environment. While we
know other factors such as amount of sleep, reading level, and previous history
of concussions influence the rate of invalid results among older athletes we
still need to gain a better understanding of what influences results among younger
athletes. It will be interesting to see if future research can shed light on
these issues and support the current findings, particularly if this research
question is explored in a randomized trial. In conclusion, these findings
support the need for younger athletes to take their standardized baseline-testing
in a small group to decrease the rate of invalid baseline tests.
Questions for Discussion:
How many athletes do you baseline test at a time? Do you have a standardized
protocol or script that you use when baseline testing athletes? How many
administrators do you believe are necessary for valid baseline testing?

by: Jane McDevitt, PhD
by: Jeffrey Driban


Lichtenstein JD, Moser RS, & Schatz P (2014). Age and test setting affect the prevalence of invalid baseline scores on neurocognitive tests. The American Journal of Sports Medicine, 42 (2), 479-84 PMID: 24243771