Citation

Houston MN, Van Pelt KL, D'Lauro C, Brodeur RM, Campbell DE, McGinty GT, Jackson JC, Kelly TF, Peck KY, Svoboda SJ, McAllister TW, McCrea MA, Broglio SP, Cameron KL. J. Int. Neuropsychol. Soc. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Cambridge University Press)

DOI

10.1017/S1355617720000594

PMID

32539884

Abstract

OBJECTIVE: In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test-retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.

METHODS: All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.

RESULTS: ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.

CONCLUSIONS: This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.

Language: en

Keywords

Mild traumatic brain injury; Balance; Change score; Neurocognitive; Neuropsychological tests; Symptoms