A Normative Reference vs. Baseline Testing Compromise for ImPACT: The CARE Consortium Multiple Variable Prediction (CARE-MVP) Norms

• Published in: Sports medicine (Auckland) 2020-08, Vol.50 (8), p.1533-1547
• Main Authors: Asken, Breton M., Houck, Zachary M., Schmidt, Julianne D., Bauer, Russell M., Broglio, Steven P., McCrea, Michael A., McAllister, Thomas W., Clugston, James R.
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; African Americans; Age; Athletes; Athletic Injuries - diagnosis; Attention Deficit Disorder with Hyperactivity; Attention deficit hyperactivity disorder; Brain Concussion - diagnosis; Cognition; Cognitive ability; Concussion; Consortia; Ethnic Groups; Female; Humans; Hyperactivity; Intelligence; Male; Medicine; Medicine & Public Health; Memory; Mental disorders; Native languages; Neuropsychological Tests - standards; Norms; Original Research Article; Reading; Reference Values; Research and Education (CARE) Consortium; Sports Medicine; Sports Medicine - standards; Standard scores; Studies; Subpopulations; The NCAA-DoD Concussion Assessment; Young Adult
• ISSN: 0112-1642; 1179-2035
• DOI: 10.1007/s40279-020-01263-2

Background Sports medicine clinicians routinely use computerized neurocognitive testing in sport-related concussion management programs. Debates continue regarding the appropriateness of normative reference comparisons versus obtaining individual baseline assessments, particularly for populations with greater likelihood of having below- or above-average cognitive abilities. Improving normative reference methods could offer alternatives to perceived logistical and financial burdens imposed by universal baseline testing. Objectives To develop and validate the Concussion Assessment, Research, and Education (CARE) Consortium Multiple Variable Prediction (MVP) norms for the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT). Methods We developed the CARE-MVP norms for ImPACT composite scores using regression-based equations. Predictor variables included sex, race (white/Caucasian, black/African American, Asian, or Multiple Races), medical history [attention-deficit/hyperactivity disorder (ADHD), learning disorder (LD), prior concussion(s), prior psychiatric diagnosis], and an estimate of premorbid intellect (Wechsler Test of Adult Reading). CARE-MVP norms were first validated in an independent sample of healthy collegiate athletes by comparing predicted and actual baseline test scores using independent-samples t -tests and Cohen’s d effect sizes. We then evaluated base rates of low scores in athletes self-reporting ADHD/LD (vs. non-ADHD/LD) and black/African American race (vs. white/Caucasian) across multiple normative reference methods (Chi square, Cramer’s V effect size). Lastly, we validated the CARE-MVP norms in a concussed sample (dependent samples t test, Cohen’s d effect size). Results A total of 5233 collegiate athletes (18.8 ± 1.2 years, 70.5% white/Caucasian, 39.1% female) contributed to the CARE-MVP norms (development N  = 2616; internal validation N  = 2617). Race and WTAR score were the strongest and most consistent ImPACT score predictors. There were negligible mean differences between observed and predicted (CARE-MVP) baseline scores (Cohen’s d