I-Team: How reliable are baseline concussion tests?

October 17, 2013

From junior highs to the NFL, there is wide disagreement in how to diagnosis concussions and then how to treat them. So pro sports teams, colleges and hundreds of high schools in Illinois have turned to computer programs to evaluate concussions. The I-Team has found questions about the reliability of those tests.

"The ball was kinda overthrown, and I reached out for it and the kid kinda blindsided me," said Branden Lowe, concussion patient.

Branden Lowe, a varsity running back at Oswego East High School, had his bell rung.

"All the rest of the kids were really excited and he just didn't seem like himself," said Dana Lowe, Branden's mother.

Small signs right after the hit became more obvious symptoms the next day: headache, dizziness and sensitivity to light.

"I told my mom and dad, 'I think I have a concussion,'" said Branden Lowe.

And because of that, under state law and the Illinois High School Association, Lowe was sidelined and required to get a doctor's permission to return to the football field.

"They might feel great but they still have signs of that concussion," said Shay Brown, athletic trainer, Oswego East High School.

At Oswego East and thousands of other schools, athletes in contact sports are also required to take a computer test called "ImPACT," the most widely-used baseline concussion screening in the country. It's billed as an objective, sophisticated tool that can detect lingering concussion symptoms. But a Loyola neuropsychologist says tests such as ImPACT are more marketing than medicine.

"I think it's a waste of time and money and provides a false sense of security. . . These tests are so unreliable that they are really not useful for what they are intended to do," said Christopher Randolph, Ph.D., neuropsychologist, Loyola University Medical Center.

He and other researchers contend baseline testing can have a significant error rate. One study from 2007 puts the number of false positives from 20 to almost 40 percent, meaning the tests can flag students as having a concussion when they don't.

"So we don't know when the baseline testing gives us a green light whether the kid is really recovered or a red light when there is really a problem," said Randolph.

Mark Lovell is one of the creators of Impact and says critics are wrong, citing 190 studies that show the test is accurate and useful. He puts the number of false positives at 10-20%, and says the 2007 study is flawed because three different types of tests were used, possibly confusing participants.

"ImPACT is much more reliable than many of the medical tests out there including mammograms, PSA testing," said Mark Lovell, Ph.D., Chief Scientific Officer at ImPACT Applications Inc.

Lovell says ImPACT wasn't designed as a cure-all, stand-alone test. He, other brain experts and some medical groups say criticism is from schools that have misused a dependable product by using ImPACT solely to determine when athletes are fit to return rather than making it part of a comprehensive concussion program.

"Right now there is no foolproof way of managing concussion and given the complexity of the brain we are not likely to have that anytime soon," said Lovell.

Ball carrier Branden Lowe passed the ImPACT re-test, but he still had to clear a series of other physical tests-- a process that kept him off the field for a few weeks.

"We are not just relying on a computer assessment to build off of, we are also using our sound judgment and also the expertise of our athletic trainers," said Louis Lee, Ed. D., principal, Oswego East High School.

Baseline testing costs schools less than $1,000 a year, but the bottom line for parents is those tests should be only part of a school head injury program. If your child's baseline reading doesn't seem right, beware: some student athletes do poorly on purpose to avoid being benched, although new tests are designed to catch cheaters. Lack of sleep affects scores according to one study, and so can distractions during tests, which are usually given in a group setting at school.

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