Assessing the predictive value of primary evaluation with the Immediate Post-Concussion Assessment and Cognitive Test following head injury

Theodore Hannah, Nickolas Dreher, Adam Y. Li, Dhruv S. Shankar, Ryan Adams, Alex Gometz, Mark R. Lovell, Tanvir F. Choudhri

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


OBJECTIVE Concussions are a major public health concern, especially for high school and college student athletes. However, there are few prognostic metrics that can accurately quantify concussion severity in order to anticipate recovery time and symptom regression. The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) is a widely used neurocognitive assessment that can diagnose and track recovery from concussions. This study assesses whether initial ImPACT scores, collected within 48 hours of the injury, can predict persistence of concussion at follow-up. METHODS Results from 6912 ImPACT tests were compiled in 2161 unique student athletes, ages 12–22 years. The authors defined a novel metric, the Severity Index (SI), which is a summation of the number of standard deviations from baseline at the 80% CI for each of the 5 composite scores reported by ImPACT. Patients were binned into groups based on SI (0–3.99, 4–7.99, 8–11.99, 12+) and the relationships between SI groups, composite scores, symptom profiles, and recovery time were characterized using 1-way and 2-way ANOVAs and Kaplan-Meier plots. A logistic regression assessed the value of SI for predicting concussion at follow-up. RESULTS Patients with a higher SI at diagnosis were more likely to still be concussed at their first follow-up (F3,2300 = 93.06; p < 0.0001). Groups with a higher SI also displayed consistently slower recovery over a 42-day period and were more likely to report symptoms in all 4 symptom clusters (Migraine, Cognition, Sleep, and Neuropsychiatric). When controlling for sex, age, number of previous concussions, days between assessments, and location, SI significantly increased the odds of being concussed at follow-up (OR 1.122, 95% CI 1.088–1.142; p < 0.001). This model showed good discrimination with an area under the curve of 0.74. CONCLUSIONS SI is a useful prognostic tool for assessing head injury severity. Concussions with higher initial SI tend to last longer and have broader symptomatic profiles. These findings can help patients and providers estimate recovery based on similar ImPACT score profiles.

Original languageEnglish
Pages (from-to)171-178
Number of pages8
JournalJournal of Neurosurgery: Pediatrics
Issue number2
StatePublished - Aug 2020


  • Concussion
  • Head injury
  • ImPACT
  • Immediate post-concussion assessment and cognitive test
  • Neuropsychological testing
  • Prognosis
  • Recovery
  • Return to play
  • Trauma


Dive into the research topics of 'Assessing the predictive value of primary evaluation with the Immediate Post-Concussion Assessment and Cognitive Test following head injury'. Together they form a unique fingerprint.

Cite this