Sensitivity of the concussion assessment battery

Sports medicine clinicians commonly use multiple tests when evaluating patients with concussion. The specific tests vary but often include symptom inventories, posturography, and neurocognitive examinations. The sensitivity of these tests to concussion is vital in reducing the risk for additional injury by prematurely returning an athlete to play. Our study investigated the sensitivity of concussion-related symptoms, a postural control evaluation, and neurocognitive functioning in concussed collegiate athletes.

From 1998 to 2005, all high-risk athletes completed a baseline concussion-assessment battery that consisted of a self-reported symptom inventory, a postural control evaluation, and a neurocognitive assessment. Postconcussion assessments were administered within 24 hours of injury to 75 athletes who had physician-diagnosed concussion. Individual tests and the complete battery were evaluated for sensitivity to concussion.

The computerized Immediate Post-Concussion Assessment and Cognitive Testing and HeadMinder Concussion Resolution Index (neurocognitive tests) were the most sensitive to concussion (79.2 and 78.6%, respectively). These tests were followed by self-reported symptoms (68.0%), the postural control evaluation (61.9%), and a brief pencil-and-paper assessment of neurocognitive function (43.5%). When the complete battery was assessed, sensitivity exceeded 90%.

Currently recommended concussion-assessment batteries accurately identified decrements in one or more areas in most of the athletes with concussion. These findings support previous recommendations that sports-related concussion should be approached through a multifaceted assessment with components focusing on distinct aspects of the athlete's function.