OBJECTIVE The most commonly used computerized neurocognitive test in concussion assessment and management, Immediate Post-concussion and Cognitive Testing (ImPACT), has demonstrated varying and sometimes concerning levels of test-retest reliability. This study aimed to further examine ImPACT's psychometric qualities and whether ceiling effects may suppress its reliability. METHOD A total of 300 consecutively selected ImPACT score reports for students attending a secondary school between 2010 and 2015 were reviewed. Test-retest reliabilities for composite scores and subscales were computed using Pearson product moment correlations (r) and intraclass correlation coefficients. To examine the potential influence of ceiling effects, we conducted frequency analyses of scores falling at, or near, the maximum possible score. RESULTS A total of 92 score reports met inclusion criteria. Test-retest reliabilities ranged from 0.42 to 0.69 for composite scores and 0.19 to 0.71 for subscales. Subscales comprising the Verbal and Visual Memory composites evidenced the most prominent ceiling effects. CONCLUSIONS Obtained test-retest reliabilities were consistent with a large segment of the literature and add to concerns about ImPACT's reliability. Furthermore, at least in a select sample, this study identified sizeable ceiling effects that likely diminish the reliability of some composite scores. To mitigate the risk of false-negative errors on post-injury testing, ImPACT users should be cognizant of such ceiling effects. Supplemental, or alternative, approaches to protect against underestimating baseline functioning also warrant consideration.

中文翻译：

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即时脑震荡后和认知测试：天花板效应、可靠性和对解释的影响

目标 脑震荡评估和管理中最常用的计算机化神经认知测试，即即刻的脑震荡后和认知测试 (ImPACT)，已经证明了不同的，有时甚至涉及重测信度的水平。本研究旨在进一步检查 ImPACT 的心理测量质量以及天花板效应是否会抑制其可靠性。方法 对 2010 年至 2015 年期间就读中学的学生的 300 份连续选择的 ImPACT 分数报告进行了审查。使用 Pearson 积矩相关性 (r) 和组内相关系数计算复合分数和分量表的重测信度。为了检查天花板效应的潜在影响，我们对落在或接近最大可能分数的分数进行了频率分析。结果 共有 92 份评分报告符合纳入标准。综合评分的重测信度介于 0.42 至 0.69 之间，分量表的重测信度介于 0.19 至 0.71 之间。包含语言和视觉记忆复合材料的分量表证明了最突出的天花板效应。结论 获得的重测信度与大部分文献一致，并增加了对 ImPACT 信度的担忧。此外，至少在选定的样本中，这项研究确定了可能会降低某些综合评分可靠性的巨大天花板效应。为了降低受伤后测试出现假阴性错误的风险，ImPACT 用户应该意识到这种天花板效应。防止低估基线功能的补充或替代方法也值得考虑。