Table 3. Studies included for the question “
Is computerised neuropsychological testing (CNT) accurate for diagnosing and
assessing recovery in SRC in children?”
Paper
Collins et
al., 2003 53
Covassin et
al., 2012 20
Participant
s
Source of
Participants
Concussion
(n=109)
High school
students
participating
in a medical
center sports
concussion
program
Concussion:
High School
(n=150)
Collegiate
(n=72)
Athletes from
an ongoing
sports
surveillance
concussion
study
Injury
Group
Age, M(SD)
15.8(1.2)
Male,
15.6(1.19)
Female,
15.43(1.22)
Assessmen
t TimePoints
(i) 5-10
days postinjury
(i) 2 days,
(ii) 7 days,
and (iii) 14
days postinjury
Neuropsychologi
cal Tests
- ImPACT
- ImPACT
Sport
Football
Basketball
Soccer
Hockey
Lacrosse
Softball
Track
Volleyball
Wrestling
Football
Soccer
Basketball
Volleyball
Wrestling
Ice hockey
Softball
Rugby Crew
Baseball
Cheerleading
Lacrosse
Injury
Group
Gender
Male
(n=93)
Female
(n=16)
Male
(n=157)
Female
(n=65)
Findings
Athletes who reported postconcussion headaches had
significantly slower reaction
times and reduced memory
performance than athletes
who were not experiencing
headaches post-injury. The
ImPACT scores were reduced
in athletes reporting
moderate to severe headache
High school athletes
performed significantly worse
than college athletes on verbal
and visual memory. Compared
with collegiate athletes, high
school athletes were still
impaired on verbal memory at
7 days post-injury.
Level of
Evidenc
e
Level 4
Level 3
Risk of Bias
6
6
Paper
Participant
s
Source of
Participants
Covassin et
al., 2010 54
Concussion
(n=72)
Athletes
participating
in high school
sports
Hang et al.,
2015 55
Concussion
(n=109)
Emergency
departments
Injury
Group
Age, M(SD)
15.8(1.34)
Range, 1118 years
Assessmen
t TimePoints
(i) Baseline,
(ii) 2 days,
(iii) 7 days,
(iv) 14 days,
(v) 21 days,
and (vi) 30
days postinjury
(i) <24
hours, (ii) 1
week, and
(iii) 2
weeks postinjury
Neuropsychologi
cal Tests
- ImPACT
- ImPACT
Sport
Baseball
Basketball
Cheerleading
Football
Gymnastics
Ice hockey
Soccer
Softball
Volleyball
Wrestling
Football
Basketball
Soccer
Baseball
Wrestling
Other
Injury
Group
Gender
Males
(n=58)
Female(
n=14)
Male
(n=86)
Female
(n=23)
Findings
Compared to baseline
performances, athletes with a
concussion revealed
significantly slower reaction
times up to 14 days postconcussion, which returned to
baseline levels by 21 days
post-injury. Concussed
athletes also showed
significant impairment on
verbal memory and motor
processing speed at 7 days
post-concussion, which
returned to baseline by 14
days post-injury.
“Poor” ImPACT performance
in the emergency department
was not useful in predicting
athletes with protracted
symptoms (1 week:
PPV=70.8%, NPV=43.5%; 2
weeks: PPV=47.8%,
NPV=68.9%).
Level of
Evidenc
e
Level 3
Level 3
Risk of Bias
6
4
Paper
Iverson et
al., 2004 56
Kontos et
al., 2012 52
Participant
s
Source of
Participants
Concussion
(n=110)
High school
athletes
participating
in a sport
medicine
concussion
program
Concussion:
High School
(n=54)
Collegiate
(n=21)
Concussion
surveillance
program
Injury
Group
Age, M(SD)
15.8(1.2)
15.74(1.28)
Assessmen
t TimePoints
(i) 5-10
days postinjury
(i) Baseline,
(ii) 2 days,
(iii) 7 days,
and (iv) 14
days postinjury
Neuropsychologi
cal Tests
- ImPACT
- ImPACT
Sport
Football
Basketball
Soccer
Hockey
Lacrosse
Softball
Track
Volleyball
Wrestling
Not reported
Injury
Group
Gender
Male
(n=93)
Female
(n=17)
Male
(n=40)
Female
(n=14)
Findings
Athletes with self-reported
persistent ‘fogginess’ had
significantly slower reaction
times, reduced memory
performance, and slower
processing speed.
Athletes demonstrated
significantly poorer verbal
memory performance at 2
days post-injury, and
significantly poorer visual
memory and reaction time at
2 days and 14 days postinjury when compared to
baseline. There were no
significant differences
between the performance of
high school and collegiate
athletes post-injury.
Level of
Evidenc
e
Level 4
Level 3
Risk of Bias
4
4
Paper
Kostyun et
al., 2015 57
Lau et al.,
2011 58
Participant
s
Source of
Participants
Concussion
(n=545)
Sports
medicine
concussion
clinic
Concussion
(n=108)
High school
football
programs
Injury
Group
Age, M(SD)
Males
14.4(11.018.8)
Females
14.6(11.018.5)
Assessmen
t TimePoints
M(SD): (i)
22(18)
days, (ii)
44(41)
days, (iii)
76(74) days
post-injury
Short
recovery
16.2
Long
recovery
15.90
(i) <72
hours, (ii) 1
week, (ii) 2
weeks, and
(iii)3 weeks
post-injury
Neuropsychologi
cal Tests
- ImPACT
Sport
Not reported
Injury
Group
Gender
Male
(n=301)
Female
(n=244)
- ImPACT
Football
Male
(n=108)
Findings
Athletes recovering from a
concussion had significantly
poorer visual memory, visual
motor speed, and reaction
time when they reported
sleeping longer than normal
prior to testing, and athletes
demonstrated significantly
poorer performance on
reaction time and visual
memory when they reported
sleeping less than normal
prior to testing.
Significant differences were
found between the athletes
with short and long recovery
for visual memory and
processing speed. The
ImPACT cognitive composite
scores correctly classified
68.35% of athletes into short
or long recovery (Se=53.20%,
Sp=75.44%).
Level of
Evidenc
e
Level 3
Level 3
Risk of Bias
5
4
Paper
Participant
s
Source of
Participants
Lovell et al.,
2003∆ 50
Concussion
(n=64)
High school
Controls
(n=24)
Injury
Group
Age, M(SD)
Not
reported
Assessmen
t TimePoints
(i) 36 hours,
(ii) 4 days,
and (iii) 7
days postinjury
Neuropsychologi
cal Tests
- ImPACT
Sport
Football
Basketball
Soccer
Other
Injury
Group
Gender
Male
(n=60)
Female
(n=4)
Findings
Athletes who had sustained a
concussion showed significant
declines in memory at 36
hours, 4 days and 7 days postinjury when compared to
baseline. Significant
differences in memory
performance were found
between athletes with
transient, and those with
more long-lasting on field
mental status changes.
Athletes with longer duration
of on-field mental status
changes were 5.3 times more
likely to demonstrate a major
drop in memory performance.
Level of
Evidenc
e
Level 3
Risk of Bias
6
Paper
Participant
s
Source of
Participants
Lovell et al.,
2004 70
Concussion
(n=43)
Sports
medicine
concussion
program
Lovell et al.,
2013 59
Concussion
(n=138)
Junior and
senior high
schools
Injury
Group
Age, M(SD)
15.6(13-18)
Range, 1018
Assessmen
t TimePoints
(i) Baseline,
(ii) <72
hours, and
(iii) 5-10
days postinjury
(i) Baseline,
and (ii) <7
days postinjury
Neuropsychologi
cal Tests
- ImPACT
- ImPACT
Sport
American
football
Soccer
Basketball
Ice hockey
Lacrosse
Baseball
Softball
Cheerleading
Injury
Group
Gender
Male
(n=35)
Female
(n=8)
Female
(n=138)
Findings
Athletes had a significantly
poorer memory performance
at <72 hours post-injury,
which returned to baseline by
6 days post-injury. There was
no significant difference
between performances at
baseline and <72 hours postinjury for reaction time and
processing speed, but athletes
performed significantly faster
at 6 days post-injury than at
baseline and the previous
time point.
Cheerleaders demonstrated a
significantly poorer
performance for visual
memory, visual motor
processing speed, and
reaction time at <7days postinjury compared to baseline.
Neurocognitive testing
identified 33% more of the
athletes as having a reliable
base-line change after injury
than symptom ratings.
Level of
Evidenc
e
Level 3
Level 3
Risk of Bias
5
4
Paper
Participant
s
Source of
Participants
Maugans et
al., 2012∆ 60
Concussion
(n=12)
Organised
sporting
events;
Referral
network of
certified
athletic
trainers,
sports
medicine
physicians
and
emergency
departments
Controls
(n=12)
Mautner et
al., 2015 61
Concussion
with selfreported dx
of ADHD
(n=70)
Concussion
without
ADHD
(n=70)
Review of
high school
athletes who
had
completed
ImPACT
testing
Injury
Group
Age, M(SD)
13.5(1.4)
Concussion
with ADHD,
15.5
Concussion
without
ADHD, 15.7
Assessmen
t TimePoints
(i) <72
hours, (ii)
14 days,
and (iii) 30
days postinjury
(i) Baseline,
and (ii) 2-3
days postinjury
Neuropsychologi
cal Tests
- ImPACT
Sport
Football
Soccer
Wrestling
Injury
Group
Gender
Male
(n=9)
Female
(n=3)
- ImPACT
American
football
Lacrosse
Soccer
Other
Male
(n=117)
Female
(n=37)
Findings
Initial post-injury reaction
time was significantly slower
in the group with concussion
than controls, persisting at 14
days and reaching control
levels by one month postinjury
Athletes with a self-reported
diagnosis of ADHD had a
longer time to recovery than
athletes without ADHD (16.5
vs 13.5 days), although this
was not statistically
significant.
Level of
Evidenc
e
Level 3
Level 3
Risk of Bias
5
3
Paper
Participant
s
Source of
Participants
McGrath et
al., 2013 71
Concussion
(n=54)
Network of
schools, and a
junior hockey
program
Pellman et
al., 2006 62
Concussion:
High School
(n=37)
Professional
(n=48)
High school
and NFL
athletes
Injury
Group
Age, M(SD)
15.46(1.48)
15.8(13-18)
Assessmen
t TimePoints
(i) Baseline,
(ii) postinjury, (iii)
symptomfree and
back to
baseline
neurocognit
ive levels,
and
(iv)postexertion
testing
(i) Baseline,
(ii) 2-3
days, and
(iii) 5 days
post-injury
Neuropsychologi
cal Tests
- ImPACT
Sport
Not reported
Injury
Group
Gender
Male
(n=43)
Female
(n=11)
- ImPACT
Football
Male
(n=37)
Findings
Concussed athletes who had
returned to baseline levels on
neurocognitive testing at rest,
but failed to perform at
baseline on post-exertion
testing, demonstrated
significantly poorer visual and
verbal memory performance
than athletes who performed
at baseline post-exertion.
High school athletes
demonstrated significantly
poorer reaction time and
processing speed than
professional NFL players at 23 days post-injury. Compared
to baseline, high school
athletes performed more
poorly for verbal memory and
reaction time at both postinjury time points.
Level of
Evidenc
e
Level 3
Level 3
Risk of Bias
6
4
Paper
Sandel et
al., 2015 63
Sandel et
al., 2013 64
Sim et al.,
2008∆ 65
Participant
s
Source of
Participants
Concussion
(n=67)
University
sports
concussion
medicine
program
Concussion
(n=101)
Concussion
(n=14)
Controls
(n=14)
Injury
Group
Age, M(SD)
14.69(1.67)
Sports
medicine
concussion
program
14.75(1.46)
Rehabilitatio
n hospital
concussion
study
15.69(1.16)
Assessmen
t TimePoints
(i) <6
months
post-injury
(median=29
days)
Neuropsychologi
cal Tests
- ImPACT
Sport
Not reported
Injury
Group
Gender
Male
(n=40)
Female
(n=27)
M(SD): (i)
80.81(149.0
7) days
post-injury
- ImPACT
(i) Baseline,
(ii) ~2.5
days, (iii) 47 days, and
(iv) 8-11
days postinjury
- ANAM
Not reported
Male
(n=62)
Female
(n=39)
Not reported
Male
(n=11)
Female
(n=3)
Findings
Moderate positive
correlations were found
between parents’ perceived
recovery and visual memory,
verbal memory, visual motor
speed, and reaction time
performance. Symptoms
reported by athletes were
more strongly associated with
parents’ perception of their
recovery, than the athletes’
performance on objective
neurocognitive testing.
Level of
Evidenc
e
Level 4
Risk of Bias
5
Verbal memory, visual
memory, and visuomotor
speed were positively related
to perceived recovery. Higher
scores on visual memory and
lower scores on reaction time
were significant predictors of
perceived recovery.
Level 4
5
Athletes with a concussion
demonstrated impairments in
reaction time and processing
speed, which returned to
baseline levels by ~6 days
post-injury. Impairments in
memory post-injury returned
to baseline levels by 10 days.
Level 3
8
Paper
Participant
s
Source of
Participants
Tsushima et
al., 2013∆ 72
Concussion
(n=26)
High school
Injury
Group
Age, M(SD)
15.20(1.73)
Assessmen
t TimePoints
M(SD): (i)
6.8(5.12)
Neuropsychologi
cal Tests
Sport
- ImPACT
Football
Soccer
Wrestling
Basketball
Softball
Judo
Lacrosse
Cheerleading
Controls
(n=25)
Injury
Group
Gender
Not
reported
Findings
There were no significant
differences between athletes
with and without a concussion
on computerised
neurocognitive testing.
Level of
Evidenc
e
Level 4
Risk of Bias
6
Vernau et
al., 2015 66
Concussion
(n=11)
Youth ice
hockey teams
13.5(9-17)
M(range):
(i) Baseline,
and, (ii)
109(38247) days
post-injury
- ImPACT
Ice hockey
Male
(n=11)
There were no statistically
significant difference between
athletes’ baseline and postinjury performances on
computerised neurocognitive
testing. There was a
statistically significant
correlation between a test of
saccadic eye movement and
visual motor and reaction
time.
Level 3
3
Virji-Babul
et al., 2014∆
Concussion
(n=9)
Residency
soccer
program and
minor league
ice hockey
teams
16.0(0.9)
M(SD): (i)
26(35) days
post-injury
- ImPACT
Not reported
Male
(n=9)
Verbal memory was
significantly higher in the
concussed group relative to
the control group. There were
no significant differences in
any of the other domains.
Level 4
6
67
Controls
(n=33)
Paper
Participant
s
Source of
Participants
Zuckerman
et al., 2015
Concussion:
Helmeted
athletes
(n=69)
Nonhelmeted
athletes
(n=69)
Middle
schools, high
schools, and
colleges
Concussion
(n=80)
Not reported
68
Zuckerman
et al., 2012
Injury
Group
Age, M(SD)
16(15-17)
Males:
15.8(1.88)
69
Females:
15.9(1.75)
∆ Risk
Assessmen
t TimePoints
M(95% CI):
(i) Baseline,
and (ii) 3(24) days
post-injury
(i) Baseline,
and (ii) <10
days postinjury
Neuropsychologi
cal Tests
- ImPACT
- ImPACT
Sport
Football
Soccer
Basketball
Wrestling
Ice hockey
Lacrosse
Soccer
Injury
Group
Gender
Male
(n=136)
Female
(n=2)
Male
(n=40)
Female
(n=40)
Findings
No significant differences
were found between
concussed athletes who wore
a helmet and those who did
not wear a helmet on
neurocognitive testing.
There were no statistically
significant differences on
neurocognitive testing
between male and female
athletes who had sustained a
concussion.
of bias assessed using NOS case-control assessment scale
ANAM, Automated Neuropsychological Assessment Metrics; ImPACT, Immediate Post-Concussion Assessment and Cognitive Test.
Level of
Evidenc
e
Level 3
Level 3
Risk of Bias
5
5