Baseline Concussion Testing – What’s the Bottom Line?
With football season nearing an end, and ice hockey and ski season just around the corner, we connected with Audrey Paul M.D. Ph.D., who is also the Founder and Medical Director of Heads Up Westport Concussion Center LLC who shared some information – and her advice – regarding baseline testing.
Fall is here, and sports are in full season. Sports related concussions are common. Between 1.6 and 3.8 million individuals are estimated to suffer from concussion each year. Over a 4 year period, an estimated 500,000 children ages 8-19 years visited the emergency department for concussion related symptoms. Diagnosis and concussion management are very controversial. There is no set gold standard for diagnosing concussions, and no magic bullet that cures concussions. There has been a lot of controversy in every aspect of concussion management. One of these areas is baseline testing.
In early 2000, thousands of athletes were mandated to be baseline tested before the start of each sports season. Baseline assessment consisted of a 20 minute computer based test called the ImPACT test. In theory baseline testing makes sense. If an athlete is concussed, you can compare his performance at the time of injury to his baseline and determine if he or she had a concussion, and when he or she has recovered. There were a lot of issues with this approach to baseline testing. Athletes would sometimes “sand bag” their baseline test so they would not be removed from play. There can be a lot of day to day variation in test performance even when baseline tests are taken by non-injured individuals. Finally, baseline testing does not prevent concussions or reduce the time to recovery. Based on these findings, a Sports Medicine Consensus Statement was issued in 2012 which stated that baseline testing is not necessary.
Move up 4 years later, and the tide has turned. The most recent Consensus Statement in 2016 now states “baseline testing may be helpful or add useful information to the overall interpretation of these tests. It also provides an additional educative opportunity for the healthcare provider to discuss the significance of this injury with the athlete.”
The CDC now recommends baseline testing for athletes engaging in contact sports. Baseline testing should also be considered for athletes with a history of learning disabilities like ADHD or dyslexia, and athletes with a significant concussion history.
Baseline testing should be multifaceted and consist of neurocognitive testing (through the ImPACT test or a similar test), balance testing and oculomotor testing. Baseline testing should also include pre-injury symptoms and a detailed medical history including asking about migraines, a history of anxiety or depression.
Bottom line? If your child is playing tackle football, ice hockey or any other contact sport, consider baseline testing.