Reliable change, sensitivity, and specificity of a multidimensional concussion assessment battery: implications for caution in clinical practice.
OBJECTIVE
To provide reliable change confidence intervals for common clinical concussion measures using a healthy sample of collegiate athletes and to apply these reliable change parameters to a sample of concussed collegiate athletes.


METHODS
Two independent samples were included in the study and evaluated on common clinical measures of concussion. The healthy sample included male, collegiate football student-athletes (n = 38) assessed at 2 time points. The concussed sample included college-aged student-athletes (n = 132) evaluated before and after a concussion. Outcome measures included symptom severity scores, Automated Neuropsychological Assessment Metrics throughput scores, and Sensory Organization Test composite scores.


RESULTS
Application of the reliable change parameters suggests that a small percentage of concussed participants were impaired on each measure. We identified a low sensitivity of the entire battery (all measures combined) of 50% but high specificity of 96%.


CONCLUSIONS
Clinicians should be trained in understanding clinical concussion measures and should be aware of evidence suggesting the multifaceted battery is more sensitive than any single measure. Clinicians should be cautioned that sensitivity to balance and neurocognitive impairments was low for each individual measure. Applying the confidence intervals to our injured sample suggests that these measures do not adequately identify postconcussion impairments when used in isolation.
Clinical Research Unit, Emergency Services Institute, WakeMed Health and Hospitals, Raleigh, North Carolina 27610, USA. jmihalik@wakemed.org
Johna K
JK
Register-Mihalik
Kevin M
KM
Guskiewicz
Jason P
JP
Mihalik
Julianne D
JD
Schmidt
Zachary Y
ZY
Kerr
Michael A
MA
McCrea
D001265:Athletic Injuries / Q000175:diagnosis*; D001930:Brain Injuries / Q000175:diagnosis; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D005538:Football / Q000293:injuries*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis*; D004856:Postural Balance / Q000502:physiology; D010818:Practice Patterns, Physicians'; D020127:Recovery of Function / Q000502:physiology; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D012494:Sampling Studies; D012678:Sensation Disorders / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult