Background

Sports medicine clinicians routinely use computerized neurocognitive testing in sport-related concussion management programs. Debates continue regarding the appropriateness of normative reference comparisons versus obtaining individual baseline assessments, particularly for populations with greater likelihood of having below- or above-average cognitive abilities. Improving normative reference methods could offer alternatives to perceived logistical and financial burdens imposed by universal baseline testing.

Objectives

To develop and validate the Concussion Assessment, Research, and Education (CARE) Consortium Multiple Variable Prediction (MVP) norms for the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT).

Methods

We developed the CARE-MVP norms for ImPACT composite scores using regression-based equations. Predictor variables included sex, race (white/Caucasian, black/African American, Asian, or Multiple Races), medical history [attention-deficit/hyperactivity disorder (ADHD), learning disorder (LD), prior concussion(s), prior psychiatric diagnosis], and an estimate of premorbid intellect (Wechsler Test of Adult Reading). CARE-MVP norms were first validated in an independent sample of healthy collegiate athletes by comparing predicted and actual baseline test scores using independent-samples t-tests and Cohen’s d effect sizes. We then evaluated base rates of low scores in athletes self-reporting ADHD/LD (vs. non-ADHD/LD) and black/African American race (vs. white/Caucasian) across multiple normative reference methods (Chi square, Cramer’s V effect size). Lastly, we validated the CARE-MVP norms in a concussed sample (dependent samples t test, Cohen’s d effect size).

Results

A total of 5233 collegiate athletes (18.8 ± 1.2 years, 70.5% white/Caucasian, 39.1% female) contributed to the CARE-MVP norms (development N = 2616; internal validation N = 2617). Race and WTAR score were the strongest and most consistent ImPACT score predictors. There were negligible mean differences between observed and predicted (CARE-MVP) baseline scores (Cohen’s d < 0.1) for all ImPACT composite scores except Reaction Time (predicted ~ 20 ms faster than observed, d = − 0.28). Low score base rates were similar for athletes across subpopulations when using CARE-MVP norms (ADHD/LD, V = 0.017–0.028; black/African American, V = 0.043–0.053); while, other normative reference methods resulted in disproportionately higher rates of low scores (ADHD/LD, V = 0.062–0.101; black/African American race, V = 0.163–0.221). Acute (24–48 h) postconcussion ImPACT scores were significantly worse than CARE-MVP norms but notably varied as a function of concussion symptom severity.

Conclusions

Results support CARE-MVP norm use in populations typically underrepresented or not adjusted for in traditional normative reference samples, such as those self-reporting ADHD/LD or black/African American race. CARE-MVP norms improve upon prior normative methods and may offer a practical, simple alternative for collegiate institutions concerned about logistical and financial burden associated with baseline testing. An automated scoring program is provided.

中文翻译：

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ImPACT的标准参考与基准测试的折衷：CARE联盟多变量预测（CARE-MVP）规范。

背景

运动医学临床医生通常在与运动有关的脑震荡管理程序中使用计算机化的神经认知测试。关于规范性参考比较与获得个人基准评估是否适当的争论仍在继续，特别是对于那些具有低于或高于平均认知能力的人群。改进规范性参考方法可以为普遍基准测试带来的后勤和财务负担提供替代方法。

目标

开发和验证脑震荡评估，研究和教育（CARE）财团的多变量预测（MVP）规范，用于即刻脑震荡后评估和认知测验（ImPACT）。

方法

我们使用基于回归的方程式开发了ImPACT综合评分的CARE-MVP规范。预测变量包括性别，种族（白人/高加索人，黑人/非裔美国人，亚洲人或多种族），病史[注意缺陷/多动障碍（ADHD），学习障碍（LD），先前的脑震荡，先前的精神病学诊断]，以及病前智力的评估（成人阅读韦氏测试）。首先通过使用独立样本t检验和Cohen d比较预测和实际基线考试成绩，在健康大学运动员的独立样本中对CARE-MVP规范进行了验证。效果大小。然后，我们通过多种标准参考方法（卡方，克拉默V效应）评估了自我报告ADHD / LD（相对于非ADHD / LD）和黑人/非裔美国人（相对于白人/高加索）运动员的低分基本率尺寸）。最后，我们验证了脑震荡样本中的CARE-MVP规范（相关样本t检验，Cohen d效应大小）。

结果

共有5233名大学运动员（18.8±1.2岁，白人/白种人为70.5％，女性为39.1％）为CARE-MVP准则做出了贡献（发展N  = 2616；内部验证N  = 2617）。种族和WTAR得分是ImPACT得分最强，最一致的预测因子。 除反应时间（预计比观察到的时间快约20 ms，d  = − 0.28）外，所有ImPACT复合评分的观察值和预测值（CARE-MVP）基线值之间的平均差异均可以忽略不计（Cohen d <0.1 ）。当使用CARE-MVP规范时，跨亚人群的运动员的低分数基准率相似（ADHD / LD，V  = 0.017–0.028；黑人/非裔美国人，V = 0.043–0.053）；同时，其他规范性参考方法导致低分数的比例过高（ADHD / LD，V  = 0.062–0.101；黑人/美国黑人，V  = 0.163–0.221）。脑震荡后急性期（24-48小时）的ImPACT评分明显低于CARE-MVP规范，但随脑震荡症状严重程度的变化而显着变化。

结论

结果支持CARE-MVP规范在传统规范参考样本（通常是自我报告的ADHD / LD或美国黑人/非裔美国人）中代表性不足或未经调整的人群中的使用。CARE-MVP规范对先前的规范方法进行了改进，并且可以为关注与基准测试相关的后勤和财务负担的大学机构提供一种实用，简单的替代方法。提供了自动计分程序。