Valid but Invalid: Suboptimal ImPACT Baseline Performance in University Athletes

Area of Science:

• Sports Medicine
• Neuropsychology
• Cognitive Assessment

Background:

• The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) is widely used for concussion management in athletes.
• Suboptimal performance on baseline ImPACT tests can complicate concussion diagnosis and management.
• Understanding the frequency and characteristics of valid yet suboptimal ImPACT scores is crucial.

Purpose of the Study:

• To determine the incidence of valid but suboptimal ImPACT test performance in university athletes.
• To evaluate the effectiveness of subsequent ImPACT test administrations in improving scores.

Main Methods:

• A descriptive laboratory study involving 769 university athletes undergoing baseline ImPACT testing.
• Athletes scoring below the 16th percentile were retested up to two additional times.
• Analysis of validity indicators and composite scores (Verbal and Visual Memory, Visual Motor Speed, Reaction Time).

Main Results:

• 14.6% of baseline ImPACT administrations were valid but had scores below the 16th percentile.
• After one retest, 71.4% of these athletes improved to ≥16th percentile; 88% improved after up to two retests.
• Verbal Memory and Visual Motor Speed were most frequently below the 16th percentile.

Conclusions:

• A significant portion of athletes exhibit valid but suboptimal baseline ImPACT scores, potentially limiting clinical utility.
• Readministration of the ImPACT test can lead to substantial score improvement in many cases.
• Further research is needed to understand the factors contributing to "valid" but suboptimal baseline performance.