title: Evaluating the "Threshold Theory": Can Head Impact Indicators Help?
abstract: This study aimed to determine the clinical utility of biomechanical head impact indicators by measuring the sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of multiple thresholds.
  
  
  
  Head impact biomechanics (n = 283,348) from 185 football players in one Division I program were collected. A multidisciplinary clinical team independently made concussion diagnoses (n = 24). We dichotomized each impact using diagnosis (yes = 24, no = 283,324) and across a range of plausible impact indicator thresholds (10g increments beginning with a resultant linear head acceleration of 50g and ending with 120g).
  
  
  
  Some thresholds had adequate sensitivity, specificity, and PV-. All thresholds had low PV+, with the best recorded PV+ less than 0.4% when accounting for all head impacts sustained by our sample. Even when conservatively adjusting the frequency of diagnosed concussions by a factor of 5 to account for unreported/undiagnosed injuries, the PV+ of head impact indicators at any threshold was no greater than 1.94%.
  
  
  
  Although specificity and PV- appear high, the low PV+ would generate many unnecessary evaluations if these indicators were the sole diagnostic criteria. The clinical diagnostic value of head impact indicators is considerably questioned by these data. Notwithstanding, valid sensor technologies continue to offer objective data that have been used to improve player safety and reduce injury risk.
authors: 1Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina, Chapel Hill, NC; 2Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina, Chapel Hill, NC; 3Injury Prevention Research Center, The University of North Carolina, Chapel Hill, NC; 4Department of Kinesiology, The University of Georgia, Athens, GA; 5Datalys Center, Indianapolis, IN; and 6Department of Epidemiology, The University of North Carolina, Chapel Hill, NC.
authors: Jason P
authors: JP
authors: Mihalik
authors: Robert C
authors: RC
authors: Lynall
authors: Erin B
authors: EB
authors: Wasserman
authors: Kevin M
authors: KM
authors: Guskiewicz
authors: Stephen W
authors: SW
authors: Marshall
mesh_terms: D061725:Accelerometry / Q000295:instrumentation; D001696:Biomechanical Phenomena; D001924:Brain Concussion / Q000175:diagnosis* / Q000503:physiopathology*; D005538:Football / Q000293:injuries*; D019416:Head Movements / Q000502:physiology*; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D055815:Young Adult