Value Of Baseline Testing In Concussion Diagnosis

Concussions pose a significant public health concern, affecting nearly 4 million individuals annually in the United States alone. Athletes at high risk of sports-related concussions often undergo baseline testing to aid concussion diagnosis and management. However, prior studies on baseline testing for concussion have shown mixed results about its benefits. PURPOSE: Our primary aim is to evaluate the value of using baseline tests compared to using normative reference values as a reference point in acute concussion diagnosis. The study further explores subgroups to discern specific populations that might benefit from baseline testing. METHODS: We analyzed data from the Concussion Assessment, Research, and Education (CARE) Consortium, focusing on athletes who underwent baseline testing and injury evaluations over a span of six years. We computed change scores for five key assessment metrics in comparison to both baseline information (from CARE Consortium) and normative reference values (from Broglio et al., 2018) and then constructed separate logistic regression models to predict concussion diagnosis. To assess the effectiveness of baseline testing, we introduce a novel metric, Diagnostic Utility of Baseline testing (DUB) where 0, -1, 1 mean equal, underperformance, and superiority of the baseline model compared to the normative model respectively. RESULTS: Our study included 1081 athletes (43.9% female) with 1279 acute concussion and 1551 baseline assessments. Our analysis showed that 86.7% of cases had comparable performance between normative and baseline models (DUB = 0). In7.5% of cases, baseline outperformed normative (DUB = 1), while in 5.8% of cases, baseline underperformed (DUB = -1). Subgroup analysis revealed that the baseline model especially underperformed for individuals with psychological disorders and depression (p < 0.01 for both groups). CONCLUSION: Our study suggests that overall, normative scores and baseline scores provide similar diagnoses in acute concussion assessment. Nevertheless, it is imperative to recognize that certain subgroups, such as those with psychological disorders and depression, are more likely to receive false-negative acute concussion assessments when using personalized baselines instead of normative reference values. This project was funded under grant no. R03HS029422 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Dept of Health and Human Services (HHS). The authors are responsible for this document's contents, findings, and conclusions, which do not necessarily represent the views of AHRQ.