Performance of the Immediate Post-Concussion Assessment and Cognitive Testing Protocol Validity Indices

Area of Science:

• Neuropsychology
• Sports Medicine
• Cognitive Assessment

Background:

• Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized tool used for concussion diagnosis in athletes.
• Baseline ImPACT scores are crucial for comparing post-injury performance, but their accuracy depends on genuine effort.
• Existing ImPACT validity indices aim to detect insufficient effort at baseline, but their effectiveness requires further examination.

Purpose of the Study:

• To evaluate the classification accuracy and concurrent validity of current ImPACT validity indices.
• To assess three proposed new indices for detecting insufficient effort during baseline ImPACT testing.
• To improve the reliability of ImPACT for concussion management.

Main Methods:

• Administered ImPACT, Word Memory Test (WMT), and MMPI-2-RF to 242 undergraduate students.
• Participants were instructed to either exert full effort or simulate symptoms of severe repetitive concussion (SRC).
• Analyzed the performance of existing and proposed ImPACT validity indices.

Main Results:

• Adjusting score thresholds for existing ImPACT validity indices marginally improved sensitivity while maintaining high specificity (0.90).
• Novel validity indices and alternative thresholds showed adequate specificity and improved overall sensitivity.
• Provided positive and negative predictive powers for various validity indices.

Conclusions:

• Current ImPACT indices may under-identify poor effort due to high specificity and lower sensitivity, potentially leading to premature return-to-play.
• Proposed improvements and additions to ImPACT validity indices can enhance sensitivity while maintaining acceptable specificity.
• Optimized validity indices are essential for protecting athletes and ensuring safe participation in sports.