Validity of Postconcussion Only Algorithms in Collegiate Athletes Following Sports-Related Concussion

Comparing preinjury baseline neuropsychological testing with postconcussion testing has become the standard in sports concussion management. However, limitations to this model have led to calls for the development of approaches that only require postconcussion testing. The present study tested evidence-based postconcussion algorithms using a hybrid neuropsychological test battery. “Recovered” and “Not Recovered” groups of concussed collegiate athletes were identified using base rate of impairment algorithms (Arnett et al., 2016). This yielded 145 Recovered and 27 Not Recovered athletes in each of 2 algorithms, and 140 Recovered and 32 Not Recovered athletes based on the combined algorithm. Outcome variables included postconcussion symptom factor scores (ImPACT Post-Concussion Symptom Scale (PCSS)), and indices of cognitive variability (Intra-Individual Standard Deviation and Maximum Discrepancy scores) across the 17 indices. Across algorithms, results consistently showed that, compared with the Recovered group, the Not Recovered group reported significantly higher Headache, Sleep, and Cognitive scores on PCSS factor scores; they also showed significantly greater cognitive variability. Inconsistent with predictions, the groups did not differ significantly on the Affective PCSS factor; results for the Physical factor weremixed. Sex differences were also observed, withmore than twice the proportion of females falling in the Not Recovered compared with the Recovered groups; these sex differences did not result in any changes in the group results when controlled for statistically.