Wednesday, June 1, 2011

Does Baseline Concussion Testing Really Reduce Risks to Athletes?

Testing Might do More Harm than Good, Loyola Researcher Reports

MAYWOOD, Ill. -- Baseline concussion tests given to hundreds of thousands of athletes might, paradoxically, increase risks in some cases, according to a Loyola University Health System researcher. The tests are likely to have a high "false negative" rate, meaning a test shows an athlete has recovered, when in fact he or she is still experiencing cognitive impairments from the concussion. This could increase risks by returning to play athletes who might otherwise be withheld for a longer period, neuropsychologist Christopher Randolph, PhD, writes in a recent issue of the journal Current Sports Medicine Reports. Baseline concussion testing is mandatory in many football, hockey and other programs, from elementary schools to the pros. Such testing provides a baseline score of an athlete's attention span, working memory, reaction time, etc. If the athlete suffers a concussion, he or she retakes the test. If there is a large decrease in the post-concussion score, the athlete typically is benched until the score increases. Randolph examined the most common baseline test, called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). The 20-minute test is taken on a computer. "There is no evidence to suggest that the use of baseline testing alters any risk from sport-related concussion, nor is there even a good rationale as to how such tests might influence outcome," Randolph writes. In searching the scientific literature, Randolph could not find a single prospective, controlled study of the current version of ImPACT (version 2.0). Such a study would involve baseline testing a large sample of athletes and then retesting concussive athletes in comparison with noninjured teammates. There was a single prospective, controlled study of an earlier version (1.0), but that study had several serious flaws, Randolph writes. Studies by independent researchers have found that the reliability of ImPACT testing "appears to be far too low to be useful for individual decision making," Randolph writes. Using baseline testing with poor sensitivity and inadequate reliability could create a false sense of security that an athlete has recovered from a concussion. Rather than relying on ImPACT or other baseline tests, team medical personnel "may be better advised to rely upon their own clinical judgment, in conjunction with a validated symptom checklist, in making return-to-play decisions," Randolph writes. Randolph is a professor in the Department of Neurology at Loyola University Chicago Stritch School of Medicine.

About Loyola University Health System

Loyola University Health System (LUHS) is part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.