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

Autor: Czerniak LL; Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI, 48109, USA. czernL@umich.edu., Liebel SW; Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA., Garcia GP; Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, 02114, USA., Lavieri MS; Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI, 48109, USA., McCrea MA; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.; Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA., McAllister TW; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA., Broglio SP; Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
Jazyk: angličtina
Zdroj: Sports medicine (Auckland, N.Z.) [Sports Med] 2021 Feb; Vol. 51 (2), pp. 351-365. Date of Electronic Publication: 2020 Dec 14.
DOI: 10.1007/s40279-020-01393-7
Abstrakt: 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.
Databáze: MEDLINE
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