Sensitivity and Specificity of the ImPACT Neurocognitive Test in Collegiate Athletes and US Military Service Academy Cadets with ADHD and/or LD: Findings from the NCAA-DoD CARE Consortium,Sports Medicine

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Sensitivity and Specificity of the ImPACT Neurocognitive Test in Collegiate Athletes and US Military Service Academy Cadets with ADHD and/or LD: Findings from the NCAA-DoD CARE Consortium
Sports Medicine ( IF 9.3 ) Pub Date : 2022-10-14 , DOI: 10.1007/s40279-022-01768-y
Lauren L Czerniak ₁ , Spencer W Liebel ₂ , Hannah Zhou ₃ , Gian-Gabriel P Garcia ₄ , Mariel S Lavieri ₁ , Michael A McCrea ₅ , Thomas W McAllister ₆ , Paul F Pasquina ₇ , Steven P Broglio ₈ ,

Affiliation

Background and Objective

Computer-based neurocognitive tests are widely used in sport-related concussion management, but the performance of these tests is not well understood in the participant population with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD). This research estimates the sensitivity and specificity performance of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computer-based neurocognitive test in identifying concussion in this population.

Methods

Study participants consisted of collegiate university athletes and military service academy cadets from the National Collegiate Athletic Association-Department of Defense CARE Consortium who completed the ImPACT test between 2014 and 2021. Participants who self-identified as belonging to one of the subgroups of interest (ADHD with or without LD [ADHD:LD+/−], LD with or without ADHD [LD:ADHD+/−], ADHD and/or LD [ADHD a/o LD]) and completed a baseline (1874 ADHD:LD+/−, 779 LD:ADHD+/−, 2338 ADHD a/o LD) or 24–48 h post-concussion (175 ADHD:LD+/−, 77 LD:ADHD+/−, 216 ADHD a/o LD) ImPACT assessment were included. Sensitivity and specificity were calculated using a normative data method and three machine learning classification methods: logistic regression, classification and regression tree, and random forest.

Results

Using the four methods, participants with ADHD:LD+/− had sensitivities that ranged from 0.474 to 0.697, and specificities that ranged from 0.538 to 0.686. Participants with LD:ADHD+/− had sensitivities that ranged from 0.455 to 0.688, and specificities that ranged from 0.456 to 0.588. For participants with ADHD a/o LD, sensitivities ranged from 0.542 to 0.755, and specificities ranged from 0.451 to 0.724.

Conclusions

For all subgroups and analytical methods, the results illustrate sensitivity and specificity values below typically accepted levels indicative of clinical utility. These findings support that using ImPACT alone may be insufficient to inform concussion diagnoses and encourages the use of a multi-dimensional concussion assessment.

中文翻译：

患有 ADHD 和/或 LD 的大学生运动员和美国军事学院学员的 ImPACT 神经认知测试的敏感性和特异性：来自 NCAA-DoD CARE 联盟的调查结果

背景和目标

基于计算机的神经认知测试广泛用于与运动相关的脑震荡管理，但在患有注意力缺陷/多动障碍 (ADHD) 和/或学习障碍 (LD) 的参与者人群中，这些测试的表现尚不清楚。本研究评估了即时脑震荡后评估和认知测试 (ImPACT) 基于计算机的神经认知测试在识别该人群脑震荡方面的敏感性和特异性表现。

方法

研究参与者包括来自美国大学体育协会-国防部 CARE 联盟的大学运动员和军校学员，他们在 2014 年至 2021 年期间完成了 ImPACT 测试。自认为属于感兴趣的亚组之一的参与者（多动症）有或没有 LD [ADHD:LD+/-]、有或没有 ADHD 的 LD [LD:ADHD+/-]、ADHD 和/或 LD [ADHD a/o LD]）并完成基线（1874 ADHD:LD+/-， 779 LD：ADHD+/-，2338 ADHD a/o LD）或脑震荡后 24-48 小时（175 ADHD：LD+/-，77 LD：ADHD+/-，216 ADHD a/o LD）ImPACT 评估被包括在内。使用规范数据方法和三种机器学习分类方法计算灵敏度和特异性：逻辑回归、分类和回归树以及随机森林。

结果

使用这四种方法，患有 ADHD:LD+/− 的参与者的敏感性范围为 0.474 至 0.697，特异性范围为 0.538 至 0.686。患有 LD:ADHD+/− 的参与者的敏感性范围为 0.455 至 0.688，特异性范围为 0.456 至 0.588。对于患有 ADHD a/o LD 的参与者，敏感性范围为 0.542 至 0.755，特异性范围为 0.451 至 0.724。