title: The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one.
abstract: BACKGROUND
  A battery of clinical measures of neurocognition, balance and symptoms has been recommended for the management of sport concussion (SC) but is based on variable evidence.
  
  
  OBJECTIVE
  To examine the sensitivity and specificity of a battery of tests to assess SC in college athletes.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Research laboratory.
  
  
  METHODS
  Division 1 athletes diagnosed with a SC (n=40) who were 20.2±1.60 years of age and 180.5±11.12 cm tall and healthy athletes (n=40) who were 19.0±0.93 years of age and 179.1±11.39 cm tall were enrolled.
  
  
  METHODS
  Participants were administered Immediate Postconcussion Assessment and Cognitive Test (ImPACT), the Sensory Organization Test (SOT) and the Revised Head Injury Scale (HIS-r) prior to and up to 24 h following injury between the 2004 and 2014 sport seasons. Sensitivity and specificity were calculated using predictive discriminant analyses (PDA) and clinical interpretation guidelines.
  
  
  METHODS
  Outcome measures included baseline and postinjury ImPACT, SOT and HIS-r composite scores.
  
  
  RESULTS
  Using PDA, each clinical measure's sensitivity ranged from 55.0% to 77.5% and specificity ranged from 52.5% to 100%. The test battery possessed a sensitivity and specificity of 80.0% and 100%, respectively. Using clinical interpretation guidelines, sensitivity ranged from 55% to 97.5% individually, and 100% when combined.
  
  
  CONCLUSIONS
  Our results support a multidimensional approach to assess SC in college athletes which correctly identified 80-100% of concussed participants as injured. When each test was evaluated separately, up to 47.5% of our sample was misclassified. Caution is warranted when using singular measures to manage SC.
authors.affiliation: Exercise and Sport Injury Laboratory Department of Kinesiology The University of Virginia , Charlottesville , VA.
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Resch
authors.affiliation: St. Mary's Athletic Training Research Laboratory, Department of Kinesiology , University of Georgia , Athens, Georgia , USA.
authors.forename: Cathleen N
authors.initials: CN
authors.lastname: Brown
authors.affiliation: St. Mary's Athletic Training Research Laboratory, Department of Kinesiology , University of Georgia , Athens, Georgia , USA.
authors.forename: Julianne
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: Atlanta Neuropsychology LLC Marble Hill , Georgia , USA.
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Macciocchi
authors.affiliation: Orthopedic Specialty Associates , Fort Worth, Texas , USA.
authors.forename: Damond
authors.initials: D
authors.lastname: Blueitt
authors.affiliation: The University of Texas Southwestern Medical Center , Dallas, Texas , USA.
authors.forename: C Munro
authors.initials: CM
authors.lastname: Cullum
authors.affiliation: The University of New Hampshire , Durham, New Hampshire , UK.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ferrara
keywords: Concussion Assessment; Mild Traumatic Brain Injury; Neurocognitive; Sensitivity; Specificity