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Evaluating the "Threshold Theory": Can Head Impact Indicators Help?

Jason P Mihalik1, Robert C Lynall, Erin B Wasserman

  • 11Department 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.

Medicine and Science in Sports and Exercise
|September 1, 2016
PubMed
Summary
This summary is machine-generated.

Biomechanical head impact indicators show high sensitivity and specificity but very low positive predictive value (PV+), questioning their clinical utility for diagnosing concussions in football players.

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Area of Science:

  • Sports Medicine
  • Biomechanics
  • Neurology

Background:

  • Concussions are a significant concern in contact sports.
  • Accurate diagnosis of concussions is crucial for player safety.
  • Biomechanical head impact sensors are being explored as potential diagnostic aids.

Purpose of the Study:

  • To evaluate the clinical utility of biomechanical head impact indicators.
  • To measure the sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of various impact thresholds.

Main Methods:

  • Collected head impact biomechanics data from 283,348 impacts in 185 Division I football players.
  • Conducted independent concussion diagnoses by a multidisciplinary clinical team (24 diagnosed concussions).
  • Analyzed impact data against multiple thresholds (50g to 120g) for diagnostic accuracy.

Main Results:

  • Some thresholds demonstrated adequate sensitivity, specificity, and negative predictive value (PV-).
  • All tested thresholds exhibited a low positive predictive value (PV+), with the highest recorded PV+ below 0.4% for all impacts.
  • Even with a five-fold increase in diagnosed concussions to account for underreporting, the maximum PV+ remained below 1.94%.

Conclusions:

  • The low positive predictive value (PV+) of head impact indicators significantly questions their clinical diagnostic value as a sole criterion.
  • High specificity and PV- are noted, but low PV+ would lead to excessive unnecessary evaluations.
  • Valid sensor technologies can still contribute to player safety and injury risk reduction through objective data.