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Sensitivity and Specificity of Computer-Based Neurocognitive Tests in Sport-Related Concussion: Findings from the NCAA-DoD CARE Consortium

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Abstract

Background

To optimally care for concussed individuals, a multi-dimensional approach is critical and a key component of this assessment in the athletic environment is computer-based neurocognitive testing. However, there continues to be concerns about the reliability and validity of these testing tools. The purpose of this study was to determine the sensitivity and specificity of three common computer-based neurocognitive tests (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], CNS Vital Signs, and CogState Computerized Assessment Tool [CCAT]), to provide guidance on their clinical utility.

Methods

This study analyzed assessments from a cohort of collegiate athletes and non-varsity cadets from the NCAA-DoD CARE Consortium. The data were collected from 2014–2018. Study participants were divided into two testing groups [concussed, n = 1414 (baseline/24–48 h) and healthy, n = 8305 (baseline/baseline)]. For each test type, change scores were calculated for the components of interest. Then, the Normative Change method, which used normative data published in a similar cohort, and the Reliable Change Index (RCI) method were used to determine if the change scores were significant.

Results

Using the Normative Change method, ImPACT performed best with an 87.5%-confidence interval and 1 number of components failed (NCF; sensitivity = 0.583, specificity = 0.625, F1 = 0.308). CNS Vital Signs performed best with a 90%-confidence interval and 1 NCF (sensitivity = 0.587, specificity = 0.532, F1 = 0.314). CCAT performed best when using a 75%-confidence interval and 2 NCF (sensitivity = 0.513, specificity = 0.715, F1 = 0.290). When using the RCI method, ImPACT performed best with an 87.5%-confidence interval and 1 NCF (sensitivity = 0.626, specificity = 0.559, F1 = 0.297).

Conclusion

When considering all three computer-based neurocognitive tests, the overall low sensitivity and specificity results provide additional evidence for the use of a multi-dimensional assessment for concussion diagnosis, including symptom evaluation, postural control assessment, neuropsychological status, and other functional assessments.

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Acknowledgements

Alphabetically by last name, the CARE Consortium investigators include: Scott A. Anderson, ATC (University of Oklahoma, USA); Holly J. Benjamin, MD, FAAP, FACSM (University of Chicago, USA); Alison Brooks, MD, MPH (University of Wisconsin-Madison, USA); Thomas Buckley, EdD, ATC (University of Delaware, USA); Kenneth L. Cameron, PhD, MPH, ATC, FNATA (United States Military Academy, USA); Sara PD Chrisman, MD, MPH (University of Washington, USA); James R. Clugston, MD, MS, CAQSM (University of Florida, USA); Stefan M. Duma, PhD (Virginia Tech, USA); James Eckner, MD, MS (University of Michigan, USA); Luis A. Feigenbaum, PT, DPT, ATC/L (University of Miami, USA); Joshua T. Goldman, MD, MBA (University of California, Los Angeles, USA); Joseph B. Hazzard Jr., ATC (Bloomsburg University, USA); Megan N. Houston, PhD, ATC (United States Military Academy West Point, USA); April Hoy, MS, ATC, CSCS (Azusa Pacific University, USA); Thomas W. Kaminski, PhD, ATC, FNAK, FNATA, FACSM, RFSA (University of Delaware, USA); Louise A. Kelly, PhD (California Lutheran University, USA); Anthony P. Kontos, PhD (University of Pittsburgh, USA); Laura Lintner, DO (Wake Forest University School of Medicine, USA); Christina L. Master, MD, FAAP, CAQSM, FACSM (University of Pennsylvania, USA); Jane McDevitt, PhD, LAT, ATC, CSCS (Temple University, USA); Gerald McGinty, PT, DPT (United States Air Force Academy, USA); Jessica Dysart Miles, LAT, ATC (University of North Georgia, USA); Chris Miles, MD (Wake Forest University, USA); Justus Ortega, PhD (Humboldt State University, USA); Nicholas Port, PhD (Indiana University, USA); Margot Putukian, MD, FACSM, FAMSSM (Princeton University, USA); Steve Rowson, PhD (Virginia Tech, USA); Julianne Schmidt, PhD, ATC (University of Georgia, USA); Joel D. Stitzel, PhD (Wake Forest University, USA); Adam James Susmarski, DO, CDR, MC, USN (United States Naval Academy, USA); Christopher T. Whitlow, MD, PhD, MHA (Wake Forest University, USA). We would also like to thank Jody Harland, Janetta Matesan, and Larry Riggen (Indiana University), Ashley Rettmann, Nicole L'Heureux (University of Michigan), Melissa Koschnitzke (Medical College of Wisconsin), Michael Jarrett, Vibeke Brinck, and Bianca Byrne (Quesgen), Thomas Dompier, Christy Collins, Melissa Niceley Baker, and Sara Dalton (Datalys Center for Sports Injury Research and Prevention), and the research and medical staff at each of the participating sites.

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Authors and Affiliations

  1. Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI, 48109, USA

    Lauren L. Czerniak & Mariel S. Lavieri

  2. Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA

    Spencer W. Liebel

  3. Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, 02114, USA

    Gian-Gabriel P. Garcia

  4. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Michael A. McCrea

  5. Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA

    Michael A. McCrea

  6. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA

    Thomas W. McAllister

  7. Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA

    Steven P. Broglio

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  1. Lauren L. Czerniak
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  2. Spencer W. Liebel
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  3. Gian-Gabriel P. Garcia
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  4. Mariel S. Lavieri
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  5. Michael A. McCrea
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Consortia

CARE Consortium Investigators

  • Scott A. Anderson
  • , Holly J. Benjamin
  • , Alison Brooks
  • , Thomas Buckley
  • , Kenneth L. Cameron
  • , Sara P. D. Chrisman
  • , James R. Clugston
  • , Stefan M. Duma
  • , James Eckner
  • , Luis A. Feigenbaum
  • , Joshua T. Goldman
  • , Joseph B. Hazzard Jr.
  • , Megan N. Houston
  • , April Hoy
  • , Thomas W. Kaminski
  • , Louise A. Kelly
  • , Anthony P. Kontos
  • , Laura Lintner
  • , Christina L. Master
  • , Jane McDevitt
  • , Gerald McGinty
  • , Jessica Dysart Miles
  • , Chris Miles
  • , Justus Ortega
  • , Nicholas Port
  • , Margot Putukian
  • , Steve Rowson
  • , Julianne Schmidt
  • , Joel D. Stitzel
  • , Adam James Susmarski
  •  & Christopher T. Whitlow

Corresponding author

Correspondence to Lauren L. Czerniak.

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Funding

This publication was made possible, in part, by support from the Grand Alliance CARE Consortium, funded by the NCAA and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014, USA, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14-2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).

Conflict of interest

Lauren L. Czerniak, Spencer W. Liebel, Gian-Gabriel P. Garcia, and Mariel S. Lavieri have no competing interests directly relevant to the content of this study. Michael A. McCrea, Thomas W. McAllister, and Steven P. Broglio received research support from the NCAA and the U.S. Department of Defense.

Ethics approval

This research study follows the standards of ethics stated in the Declaration of Helsinki.

Consent to participate

All individuals provided written informed consent which was approved by the local institution and the US Army Human Research Protection Office.

Consent for publication

CARE Consortium Review Board as well as the US Army Human Research Protection Office.

Availability of data and material

The NCAA-DoD CARE dataset is available in the FITBIR database (https://fitbir.nih.gov/).

Code availability

The R code is accessible by contacting the corresponding author.

Author contributions

LLC performed all data analysis, created and formatted tables and figures, and was a major contributor in writing the manuscript. SWL was a major contributor in writing the manuscript. GPG contributed greatly in data acquisition, data analysis, and writing the manuscript. MSL contributed to the design of the statistical analysis and writing of the manuscript. MAM and TM helped with data collection, securing funding, and final approval of the manuscript. SPB helped with the study design, securing funding, data interpretation, drafting and final approval of the manuscript.

Additional information

This article is part of a Topical Collection on The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium.

The members of the CARE Consortium Investigators are listed in acknowledgements.

Supplementary Information

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Czerniak, L.L., Liebel, S.W., Garcia, GG.P. et al. Sensitivity and Specificity of Computer-Based Neurocognitive Tests in Sport-Related Concussion: Findings from the NCAA-DoD CARE Consortium. Sports Med 51, 351–365 (2021). https://doi.org/10.1007/s40279-020-01393-7

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