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New validity indicators for Immediate Post-Concussion and Cognitive Testing (ImPACT) show improved accuracy in detecting invalid performance. These novel indicators offer flexibility for optimizing sensitivity or specificity in concussion assessments.

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Area of Science:

  • Neuroscience
  • Sports Medicine
  • Psychometrics

Background:

  • Concussion assessment relies on valid cognitive testing.
  • Existing embedded validity indicators (EVIs) for Immediate Post-Concussion and Cognitive Testing (ImPACT) have limitations in accuracy.
  • There is a need for improved methods to detect invalid performance in ImPACT assessments.

Purpose of the Study:

  • To develop novel ImPACT-based embedded validity indicators (EVIs).
  • To compare the classification accuracy of new EVIs against existing ImPACT validity measures.
  • To evaluate the ability of new indicators to detect invalid cognitive performance.

Main Methods:

  • Administered ImPACT to 82 male varsity football players for baseline testing.
  • Developed and tested two new EVIs: ImPACT-5A (liberal cutoff) and ImPACT-5B (conservative cutoff).
  • Compared classification accuracy of ImPACT-5A/B with four existing EVIImPACT measures.

Main Results:

  • ImPACT-5A showed high sensitivity (0.81) but low specificity (0.49) for invalid performance.
  • ImPACT-5B demonstrated high specificity (0.98) but low sensitivity (0.22).
  • Combined ImPACT-5A/B cutoffs met forensic specificity standards (0.91-0.93) with 0.33-0.37 sensitivity and showed the strongest relationship with invalid performance.

Conclusions:

  • The novel ImPACT-5s EVIs are superior to standard EVIImPACT and comparable to aftermarket EVIs.
  • These new indicators provide flexibility to optimize detection models for sensitivity or specificity.
  • The range of ImPACT-5 cutoffs allows for more nuanced clinical interpretation of concussion test validity.