Citation

Hannah T, Dreher N, Li AY, Shankar DS, Adams R, Gometz A, Lovell MR, Choudhri TF. J. Neurosurg. Pediatr. 2020; ePub(ePub): ePub.

Affiliation

1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York.

Copyright

(Copyright © 2020, American Association of Neurological Surgeons)

DOI

10.3171/2020.2.PEDS19709

PMID

32384275

Abstract

OBJECTIVE: Concussions are a major public health concern, especially for high school and college student athletes. However, there are few prognostic metrics that can accurately quantify concussion severity in order to anticipate recovery time and symptom regression. The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) is a widely used neurocognitive assessment that can diagnose and track recovery from concussions. This study assesses whether initial ImPACT scores, collected within 48 hours of the injury, can predict persistence of concussion at follow-up.

METHODS: Results from 6912 ImPACT tests were compiled in 2161 unique student athletes, ages 12-22 years. The authors defined a novel metric, the Severity Index (SI), which is a summation of the number of standard deviations from baseline at the 80% CI for each of the 5 composite scores reported by ImPACT. Patients were binned into groups based on SI (0-3.99, 4-7.99, 8-11.99, 12+) and the relationships between SI groups, composite scores, symptom profiles, and recovery time were characterized using 1-way and 2-way ANOVAs and Kaplan-Meier plots. A logistic regression assessed the value of SI for predicting concussion at follow-up.

RESULTS: Patients with a higher SI at diagnosis were more likely to still be concussed at their first follow-up (F3,2300 = 93.06; p < 0.0001). Groups with a higher SI also displayed consistently slower recovery over a 42-day period and were more likely to report symptoms in all 4 symptom clusters (Migraine, Cognition, Sleep, and Neuropsychiatric). When controlling for sex, age, number of previous concussions, days between assessments, and location, SI significantly increased the odds of being concussed at follow-up (OR 1.122, 95% CI 1.088-1.142; p < 0.001). This model showed good discrimination with an area under the curve of 0.74.

CONCLUSIONS: SI is a useful prognostic tool for assessing head injury severity. Concussions with higher initial SI tend to last longer and have broader symptomatic profiles. These findings can help patients and providers estimate recovery based on similar ImPACT score profiles.

Language: en

Keywords

AUC = area under the curve; ImPACT; ImPACT = Immediate Post-Concussion Assessment and Cognitive Test; Immediate Post-Concussion Assessment and Cognitive Test; PCSS = Post-Concussion Symptom Scale; PI1 = first postinjury test; PI2 = second postinjury test; SI = Severity Index; Sdiff = standard error of difference at the 80% CI; concussion; head injury; neuropsychological testing; prognosis; recovery; return to play; trauma; ΔScore = changes in composite scores