Concussion Testing: How Sure Are We When It Comes To Traumatic Brain Injuries?

As a huge sports fan, every time I see a player from one of my favorite teams go down with a head injury, I’m always worried to hear the commentators say the C word. We heard this scary C word a couple of weeks ago when P.K. Subban was stretchered off the ice during a game between the Montreal Canadiens and the Buffalo Sabers. Does Subban have a concussion? How long will he be out for? How serious of a concussion might this be? Thankfully, in this case it seems as though Subban did not suffer a concussion, only a sprained neck.

On the bright side, as was seen with the open discussion regarding the Subban injury, the stigma associated with traumatic head injuries in professional sports seems to have mostly disappeared over recent years. Players are now more likely to admit their symptoms and take some time away from games and practices in order to properly recover. With this new found openness to discuss head injuries, we must now turn to the tests used to diagnose concussions and to determine when a player is ready to resume play, to make sure that athletes with concussions are being properly taken care of.

A wide range of concussion testing tools are currently being used by medical professionals for the diagnosis and treatment of head injuries. These tools can be classified into two broad groups: those meant to assess the injury and those meant to manage the injury. Various tools such as the Modified Glasgow Coma Scale, Sport Concussion Assessment Tool 2, Standardized Assessment of Concussion (SAC), and the King-Devick Test, are widely used in the diagnosis of concussions. For the management of the injury (keeping track of an athletes recovery and determining when they are fit to play), the Immediate Post-Concussion Assessment Cognitive Test (ImPACT) is widely used. This computerized neuropsychological test measures attention, working memory, processing speed, response variability, and nonverbal problem solving.

Some important problems arise with the previously mentioned tests. When trying to diagnose a concussion, the specific test used might provide a different result than one of the other tests for that injury. It is quite problematic if an athlete is determined as concussed through one test, but is not determined as concussed through another. If an athlete is taken out of a game to undergo concussion testing and is seen to be okay in one test, can we confidently say that this athlete would test negatively for a concussion on all other tests? Currently, no.

There are also major limitations to the management of a concussion. For the ImPACT test to be truly meaningful, the patients’ scores on the battery of tests must be compared to their baseline when not concussed. Very few athletes, especially at the amateur level, have the possibility of completing this test prior to actually being evaluated for a concussion. When this is the case, medical professionals are able to see how this person performs currently on the ImPACT test, but are unable to compare it to any meaningful other score.

As previously mentioned, it’s great that athletes are becoming more and more comfortable disclosing their head injuries and taking concussions seriously. It’s now up to researchers and clinicians to ensure that the tools they are using to diagnose and manage these traumatic injuries are accurate and reliable, so that people suffering from concussions receive the best treatment possible.