Citation

Lau BC, Collins MW, Lovell MR. Neurosurgery 2012; 70(2): 371-9; discussion 379.

Affiliation

University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Orthopedic Surgery, University of Pittsburgh Medical Center Sports Concussion Program, Pittsburgh, Pennsylvania.

Copyright

(Copyright © 2012, Congress of Neurological Surgeons)

DOI

10.1227/NEU.0b013e31823150f0

PMID

21841522

Abstract

BACKGROUND:: Many studies address diagnosing concussions but few look at predicting prognosis. A prior discriminant function analysis showed that symptom clusters derived from the Post-Concussion Symptom Scale (PCSS) and ImPACT composite scores used together improved predictions of protracted recovery following a sports-related concussion. OBJECTIVE:: To determine cutoff scores in neurocognitive and PCSS symptom cluster scores when classifying protracted recovery in concussed athletes. METHODS:: 108 male high school football athletes completed a computer-based neurocognitive test battery (ImPACT) within a median of 2 days following injury. Patients completed graded exertional protocols requiring athletes to be symptom free at rest and during increasing levels of activity and had recovery of neurocognitive scores before return-to-play. Following return-to-play, athletes were classified as protracted recovery (>14 days, N=58) or short-recovery (≤14 days, N=50). ROC curves analyzed each of the neurocognitive (verbal, visual, processing speed, and reaction time) and symptom cluster (migraine, cognitive, sleep, and neuropsychiatric) scores. RESULTS:: Cutoffs for migraine cluster, cognitive cluster, visual memory, and processing speed were statistically significant. Cutoffs at 75%, 80%, and 85% sensitivity to predict protracted recovery for the migraine symptom cluster were ≥15, 18, 20; cognitive symptom cluster ≥18, 19, 22; visual memory ≤48, 46, 44.5; and processing speed ≤24.5, 23.46, 22.5; respectively. Eighty-percent sensitivity indicates that the corresponding cutoff correctly identify 80% of concussed athletes requiring protracted recovery. CONCLUSION:: Specific cutoffs may help to set numerical thresholds for clinicians to predict which concussed athletes will have a protracted recovery.

Keywords: American football;

Language: en