title: Can Computerized Neuropsychological Testing in the Emergency Department Predict Recovery for Young Athletes With Concussions?
abstract: OBJECTIVE
  The objective of this study was to determine if computerized neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]) in the emergency department (ED) can be used as a prognostic tool to detect young athletes at risk of having protracted concussive symptoms.
  
  
  METHODS
  This was a prospective cohort study of athletes aged 11 to 18 years who presented to an ED less than 24 hours after sustaining a sports-related concussion. ImPACT was administered in the ED, and performance was categorized as "poor" if the athlete had 3 (of 4) or greater low domain scores. Participants completed the Post-Concussion Symptom Scale (PCSS) in the ED and by phone at 1 and 2 weeks after injury. Athletes were symptomatic if their PCSS score was more than 6 in males and more than 8 in females.
  
  
  RESULTS
  One hundred nine patients were enrolled; 60% and 36% remained symptomatic at 1 and 2 weeks after injury, respectively. "Poor" ImPACT performance was not particularly useful in predicting athletes with protracted symptoms (at 1 week: positive predictive value, 70.8%; negative predictive value, 43.5%; at 2 weeks: positive predictive value, 47.8%; negative predictive value, 68.9%). In bivariate analysis, a higher ED PCSS score was associated with protracted symptoms (at 1 week: odds ratio, 1.1 [confidence interval, 1.0-1.1]; at 2 weeks: odds ratio, 1.0 [confidence interval, 1.0-1.1]).
  
  
  CONCLUSIONS
  Computerized neurocognitive testing in the ED has limited usefulness in predicting protracted symptoms. Total acute symptom burden may be a useful prognostic tool in the ED evaluation of concussed young athletes, yet further research is necessary.
authors.affiliation: From the *Pediatric Emergency Medicine, Division of Emergency Medicine, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, IL; and †Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and ‡UC Department of Pediatrics, Cincinnati, OH.
authors.forename: Brian
authors.initials: B
authors.lastname: Hang
authors.forename: Lynn
authors.initials: L
authors.lastname: Babcock
authors.forename: Richard
authors.initials: R
authors.lastname: Hornung
authors.forename: Mona
authors.initials: M
authors.lastname: Ho
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Pomerantz
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis* / Q000523:psychology; D001924:Brain Concussion / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D003201:Computers; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013334:Students