Determining the False Positive Rate of a Concussion Battery in Healthy Division I Collegiate Athletes
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Master of Science in Kinesiology (M.S.)
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Thesis (open access)
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This work is licensed under a Creative Commons Attribution 4.0 License.
Department of Health and Kinesiology
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Context: Athletic participation accounts for 1.6-3.8 million concussions, or mild traumatic brain injuries (mTBI) every year in the United States. Accurate assessment and diagnosis of concussions is critical to protect athletes from further injury. The Fourth International Conference on Concussion in Sport Consensus Statement recommends a multifaceted concussion assessment which includes symptom inventories, postural stability assessment, and neurocognitive testing. The accuracy of each test is vital in correctly diagnosing concussions. The Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) are among the most commonly used assessment tools by NCAA athletic trainers.
Objectives: (1) evaluate the false positive rate of a clinical concussion assessment battery (BESS, SAC, ImPACT) in a healthy Division I collegiate athlete population and (2) identify trends in pass/fail rates based on months elapsed from baseline testing.
Design: Prospective longitudinal study.
Setting: A large university in southeast Georgia.
Participants: Fifty Division I collegiate athletes were recruited as participants. Forty-eight participants fulfilled the study requirements.
Main Outcome Measure(s): Descriptive statistics were run for all demographic variables, along with scores on the various dependent variables. Failure rates for each test were then determined. Any increase in BESS score, decrease in SAC score, or change in an ImPACT composite score exceeding the reliable change index was classified as a false positive for the concussion battery. A one-way repeated measures ANOVA was run to determine changes in scores by testing time (baseline vs. current) and time elapsed from baseline. Tukey post-hoc testing and planned simple contrasts were evaluated as needed.
Results: The concussion battery produced an 81% false positive rate. BESS produced the most false positives (62.5%), followed by ImPACT (33.3%), and SAC (27.1%). No significant interactions were found between the time from baseline testing and differences in scores from baseline to current testing. There was a significant main effect across time between BESS baseline scores and testing scores.
Conclusions: Eighty-one percent of participants demonstrated a deficit from their baseline scores on one or more of the assessments, thus failing the concussion battery and giving objective evidence of a possible concussion. When a patient fails an objective assessment used to identify and diagnose a concussion, they are at risk of being removed from all participation. To return to participation, the current recommendation is a symptom free graduated return to play protocol taking about seven days to complete. This may result in significant playing time lost for the athlete.