Immediate Post-Concussion Assessment And Cognitive Testing Research Articles

B - 38 Concussion Clinical Outcomes and Recovery Time in Individuals with Pre-Existing Anxiety and/or Depression

Abstract Objective Post-injury anxiety and mood difficulties are common symptoms following concussion. However, limited research has explored the impact of anxiety and/or depression history on individuals’ clinical outcomes and recovery time post- concussion. This study aims to determine the influence of anxiety and/or depression history on individuals’ clinical outcomes and examine outcomes of those with both anxiety and depression history. Method We conducted a retrospective review of 297 concussed patients. All participants completed a clinical interview, Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Clinical Profile Screen (CP-Screen), and Vestibular/Ocular-Motor Screening (VOMS). Participants were categorized into one of three anxiety-depression subgroups — no anxiety or depression history (NONE), anxiety or depression history (EITHER), or anxiety and depression history (BOTH)— based on clinical interviews. Results The BOTH group reported higher symptom burden (CP Screen Total Score; p < 0.001) and performed worse on ImPACT Visual Memory (p = 0.03) compared to NONE and EITHER groups. Overall, recovery time differed significantly between groups (p = 0.006). The NONE group recovered significantly faster than the EITHER group (p = 0.04), and the BOTH group (p = 0.03). However, no significant difference in recovery time was noted between the EITHER and BOTH groups (p = 0.58). Conclusions Our results suggest that anxiety/depression history is associated with more severe post-concussion symptoms, worse visual memory, and longer recovery times when compared to those with no history of anxiety or depression. These findings highlight the importance of screening for anxiety and depression history in clinical settings and exploring ways to improve concussion recovery for individuals with anxiety and/or depression history.

Valid, invalid, or somewhere in between? Baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and stand-alone performance validity testing in collegiate athletes.

Valid, invalid, or somewhere in between? Baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and stand-alone performance validity testing in collegiate athletes.

Effects of repetitive subconcussive head trauma on the neuropsychological functioning and symptom reporting of high school athletes in high and low contact sports: Age and sex.

The present study was designed to assess the neuropsychological test performances of non-concussed female and male high school athletes of different ages in high and low contact sports. Large samples of 2,510 high school athletes in High Contact sports (e.g., football) and 1,437 in Low Contact sports (e.g., basketball) were examined. The participants were administered a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) prior to their respective seasons. Multivariate linear regression showed that the High Contact athletes had significantly poorer results than the Low Contact athletes in all four ImPACT Composite scores and the Total Symptom scores. No age differences were found, but in all three age groups, the High Contact athletes had lower Visual Motor Speed scores than the Low Contact athletes. No test score differences were noted between the females in the High and Low Contact groups, but the High Contact males had poorer Visual Motor Speed and Reaction Time than the Low Contact males. The present results were consistent with prior studies of subconcussive head trauma, with High Contact athletes obtaining overall poorer neuropsychological test results than Low Contact athletes. More investigations in this age group seems is warranted.

A - 27 A Preliminary Investigation of the Relationship between Sleep Symptoms and Post-Concussion Cognitive Performance in Adolescents

Abstract Purpose To explore the relationship between self-reported sleep symptoms and post-concussion cognitive test performance in adolescents on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Method 54 adolescents (ages 12–16) referred to a specialized sports concussion private practice completed post-concussion ImPACT. Five symptom clusters were derived from the post-concussion symptom scale: sleep, physical, cognitive, affective, and headache. Two-factor cognitive composites from the ImPACT (memory and speed) were the outcome variables. Multivariate linear regression was conducted to examine the relationship between cognitive variables and sleep symptoms. Post-hoc forward stepwise linear regressions were used to explore the following potential additional predictors of cognitive outcomes: age, number of previous concussions, sex, hours slept the night before, and five symptom clusters. Results Sleep symptoms were significantly associated with cognitive performance, F(1,52) = 9.95, p < 0.001, ƞ2 = 0.28. Higher sleep symptom cluster scores were associated with worse memory, F(1,53) = 13.68, p < 0.001, ƞ2 = 0.21, and speed performance, F(1,53) = 17.84, p < 0.001, ƞ2 = 0.26. Results of post-hoc forward stepwise linear regressions revealed that a final model for speed performance included only the sleep symptom cluster, explaining 16.6% of the variance. The final model for memory performance included only the headache rating, explaining 20.1% of the variance. Conclusions Our results indicate that severity of self-reported sleep symptoms post-concussion are associated with cognitive performance in domains of memory and speed. After considering additional predictors, more severe sleep symptoms were significantly associated with worse speed performance and worse headache severity was significantly associated with memory performance.

A - 33 Examining Neurocognitive Effects of Contact Exposure in High School Athletes

Abstract Purpose Concerns have been raised about the effect of repetitive head impacts and subconcussive blows in contact sports, though studies have largely focused on the effect in late-life or retired professional athletes. We examined the effect of extended participation (months-to-years) in low/non-contact vs high contact/collision sports within a sample of high school athletes on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Method A multisport sample of 1650 athletes (34% Female; 1088 contact, 528 non-contact; age 14–18) without a history of concussion completed baseline ImPACT testing across two times points (time between administrations ranging from 7–45 months; M = 20.40), with active sport participation between administrations. Results Repeated mixed-measure ANOVA revealed increased performance across ImPACT administrations for all composites (p < 0.001; partial Œ∑2 = 0.02–0.23). With the exception of a very small effect on Impulse Control composites (partial Œ∑2 = 0.003), there was no statistically significant difference between high contact and low contact sport groups across composite scores (p < 0.05). Conclusions Our findings showed no meaningful changes in neurocognitive performance in high school athletes exposed to high degrees of contact sports for months/years, with both contact groups demonstrating a consistent mild–moderate practice effect over time. This also aligns with the recent systematic literature review finding no increased risk of neurological/neurocognitive disease in amateur contact athletes in later life (Iverson et al, 2023). Future prospective studies with longer follow up and incorporation of additional measures (e.g., mental health, expanded testing, and biomarkers) will be important to improve our understanding of the risk of contact exposure in athletes.

A - 49 Predictors of Post-Concussion Anxiety In Patients without Pre-Existing Anxiety History

Abstract Purpose Identify factors contributing to anxiety in individuals without a pre-existing anxiety history post-concussion. Method Patients (n = 264, aged 9–68) presented to a specialty concussion clinic post-concussion. They completed a clinical interview, Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profile Screening (CP-Screen), and Vestibular/Ocular-Motor Screening (VOMS). Anxiety group was determined by a positive anxiety/mood clinical profile on CP-Screen. Independent samples t-tests and chi-square tests examined differences in demographics, medical history, and injury characteristics between groups. Univariate logistic regressions (LR) informed a follow-up forward stepwise LR to identify best predictors of post-concussion anxiety group. Receiver operating characteristic (ROC) analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best-discriminated anxiety status. Statistical significance was set a priori at p < 0.05. Results Results of forward stepwise LR identifying factors contributing to post-concussion anxiety were significant (p < 0.001) and accounted for 19% of the variance. The model accurately classified 82.2% of patients, with non-Sport Related Concussion (SRC) (OR = 2.94, 95%CI, 1.45–1.5.98, p = 0.003), history of ADHD/LD (OR = 2.85, 95%CI, 1.21–6.71, p = 0.02), positive vestibular profile (OR = 2.14, 95%CI, 1.06–4.33, p = 0.03), and days to first clinic visit (OR = 1.01, 95%CI, 1.01–1.015, p = 0.003) as significant predictors. ROC analysis of the AUC of this 4-factor model discriminated post-concussion anxiety from no anxiety (AUC, 0.77, 95%CI, 0.71–0.85, p < 0.001). Conclusions Findings suggest that non-SRC, ADHD/LD history, positive vestibular profile, and delayed clinic visit, may contribute to post-concussion anxiety among patients without prior anxiety history. These predictors may guide clinicians in tailoring interventions to optimize recovery outcomes.

Influence of social determinants of health and adversity on computerized neurocognitive assessment

Introduction: Social determinants of health and adversity, including poverty, maltreatment, and neighborhood deprivation, are individual-level factors that may significantly affect baseline neurocognitive testing and management that have yet to be thoroughly explored within the computerized neurocognitive assessment.Objectives: Examine individual-level experiences of poverty, abuse, neighborhood deprivation, and social mobility on computerized cognitive testing.Methods: The sample included 3,845 student-athletes who completed a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and were enrolled in the Child-Household Integrated Longitudinal Data database. Multivariable linear regressions were used to assess independent variables of Supplemental Nutrition Assistance Program enrollment, abuse or neglect cases, Area Deprivation Index scores, and other demographic factors on four baseline ImPACT composite scores: verbal and visual memory, visuomotor, and reaction time.Results: Individual-level factors of persistent poverty and neighborhood deprivation were associated with lower composite scores; however, upward social mobility was not significantly associated with cognitive performance. The effects of mother’s race on computerized cognitive testing performance were attenuated when accounting for measures of adversity.Conclusion: Findings highlight the importance of social determinants of health in computerized neurocognitive testing to ensure more culturally sensitive and precise understanding of athletic baselines.

Effects of hours of sleep on ImPACT concussion testing: comparing baseline with postinjury scores.

The influence of sleep on baseline and postconcussion neurocognitive performance prior to Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is poorly understood. Since ImPACT is widely used in youth sport to assess neurocognitive performance before and after head injury, it is important to delineate factors that affect testing performance. While some have reported correlations between fewer hours of sleep and lower scores on baseline tests, others have not observed any such associations. Therefore, the authors sought to compare the relationship between sleep and neurocognitive performance on ImPACT at both baseline and postinjury. The authors queried a database of 25,815 ImPACT tests taken from 2009 to 2019 by athletes aged 12-22 years. There were 11,564 baseline concussion tests and 7446 postinjury concussion ImPACT tests used in the analysis. Linear regression was used to model the effect of sleep on baseline and postconcussion ImPACT scores adjusting for sex, age, learning disability, attention-deficit/hyperactivity disorder, number of prior concussions, number of games missed, and strenuous exercise before testing. Mean composite scores expectedly were all significantly lower in the post-head injury group compared with the baseline group. In the multivariable analysis, at baseline, hours of sleep significantly affected symptom scores (β = -1.050, 95% CI -1.187 to -0.9138; p < 0.0001). In the postinjury multivariable analysis, verbal memory (β = 0.4595, 95% CI 0.2080-0.7110; p = 0.0003), visual memory (β = 0.3111, 95% CI 0.04463-0.5777; p = 0.0221), impulse control (β = -0.2321, 95% CI -0.3581 to -0.1062; p = 0.0003), and symptom scores (β = -0.9168, 95% CI -1.259 to -0.5750; p < 0.0001) were all affected by hours of sleep. Hours of sleep did not alter neurocognitive metrics at baseline but did have an impact on post-head injury metrics. These findings suggest that individuals may be able to compensate for lack of sleep at baseline but not immediately after concussion. Concussions may reduce cognitive reserve or detract from the brain's resources, making sleep even more important for proper neurocognitive functioning postconcussion. Future work will analyze the effects of sleep on postconcussion test performance.

Experiences of Adversity and Validity of Baseline Concussion Testing.

Neurocognitive testing is a critical tool in the management of sport-related concussions. Adversity during childhood and adolescence affects cognitive tasks, behavioral outcomes, and academic performance. Adversity may be important in baseline concussion test validity as well; however, the influence of these experiences is not well understood. To examine the relationship between individual-level experiences of adversity and baseline test validity of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). We hypothesized that experiences of poverty, maltreatment, or extreme neighborhood deprivation would be associated with lower odds of baseline test validity. Case-control study. Cuyahoga County, Ohio. A total of 6495 student-athletes born from 1995 through 2005 who completed a baseline ImPACT test between 10 and 18 years old and were identified in the Child-Household Integrated Longitudinal Data system, a comprehensive data system with demographic and social service usage outcomes for children in Cuyahoga County, Ohio. Baseline concussion test validity was determined using the ImPACT built-in validity measure. Experiences of adversity during the sensitive developmental periods of early childhood and adolescence were key independent variables. Our findings suggested that social mobility may play an important role in baseline validity. Youth with upward social mobility (ie, poverty or neighborhood deprivation in early childhood only) were not different from youth without such experiences (odds ratio [OR] = 0.91, P = .74). Youth with persistent adversity across childhood or downward social mobility (ie, poverty or high neighborhood deprivation in adolescence only) had 50% to 72% lower odds of achieving a valid baseline test (persistent poverty, OR = 0.59, P = .05; adolescent poverty only, OR = 0.50, P = .004; adolescent neighborhood deprivation only, OR = 0.28, P < .001). Maltreatment had no significant effect on test validity. These findings indicated that certain patterns of adversity may predispose youth to invalid baseline testing scores, potentially increasing their risk of inappropriate injury management and poor outcomes.

The Influence of the COVID-19 Pandemic on Baseline Concussion Symptom Assessments Among Adolescents.

Introduction The COVID-19 pandemic resulted in the cancellation of high school sports in spring 2020, a modified resumption of sports in the 2020-2021 academic year, and a return to pre-pandemic sports in 2021-2022. This cancellation had a major impact on the quality of life of adolescent athletes, but it is unknown exactly how these pandemic-driven sports disruptions on athlete baseline (preseason) symptoms affected quality of life. Therefore, the current study retrospectively evaluated symptom inventories from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assessments to determine whether the cancellation of sports during the COVID-19 pandemic affected baseline (preseason) self-reported symptoms among adolescent athletes. Methods Our study used a retrospective cohort design to evaluate high school athletes with complete ImPACT assessments in the academic years before (2018-2019 and 2019-2020), during (2020-2021), and after (2021-2022) the pandemic. Specifically, data from a 22-item symptom report called the Post-Concussion Symptom Scale (PCSS) assessed during ImPACT was collected and analyzed using generalized linear models with a Tweedie exponential dispersion model and post hoc Tukey's honestly significant difference tests. The main outcomes were the total symptom severity score and the affective cluster score. Secondary outcomes were the analysis of the vestibular-somatic, cognitive-sensory, and sleep-arousal symptom clusters. Results Of the 104,274 ImPACT assessments, the total symptom severity score on the PCSS was different across years (p<0.001). There were lower symptom scores in 2020-2021 (5.33, 95% CI = 5.13-5.54) than in 2018-2019 (6.82, 95% CI = 6.63-7.01), 2019-2020 (6.94, 95% CI = 6.75-7.14), and 2021-2022 (6.44, 95% CI = 6.25-6.64). The cluster scores on the PCSS for affective, cognitive-sensory, sleep-arousal, and vestibular-somatic were also lower (p<0.001) in 2020-2021 than in 2018-2019, 2019-2020, and 2021-2022. Conclusion Contrary to our expectations, total symptom severity and cluster scores on the PCSS during the pandemic (2020-2021) were significantly lower than during the years before and after the pandemic-driven sports disruptions, suggesting the pandemic did not negatively affect these athletes as expected. These results also suggested that self-reported symptoms utilized in the PCSS component of ImPACT may not be as sensitive to sports disruption among adolescent athletes as other quality-of-life measures, especially during the COVID-19 pandemic.

Neurocognitive Concussion Test Performance for Student Athletes on the Autism Spectrum.

To examine baseline neurocognitive functioning among adolescent athletes on the autism spectrum based on self-reported level of academic performance. Participants in this cross-sectional, observational study were 6,441 adolescent athletes with a self-reported diagnosis of autism who completed pre-season neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); 4,742 reported a co-occurring learning disorder (LD), and 6,612 individuals without autism or LD were included as a control group. The majority (57%) self-reported Average Academic Performance, 39% Above Average, and 4% Below Average performance. Athletes with self-reported autism (with or without LD; 12.2%) were 2.74x (95% CI: 2.17-2.82) more likely to fall below cutoffs for ImPACT Embedded Invalidity Indicators (EVIs), with a significant interaction between self-reported Diagnosis and Academic Performance; individuals with co-occurring autism and LD who reported Below Average Academic Performance had the greatest likelihood of scoring below cutoffs (22%), followed by ASD without LD (14.8%) and Controls (14.6%) with Below Average Academic Performance. Analyses of variance (ANOVAs) revealed main effects of Diagnosis and Academic Performance on neurocognitive performance, with interactions on all ImPACT Composite Scores except Processing Speed. Athletes with self-reported ASD are more likely to fall below ImPACT EVIs and score worse on ImPACT, with greater likelihood/worse performance related to level of academic functioning. Academic performance should be considered when interpreting neurocognitive testing data, to best index neuropsychological functioning associated with concussion in this population. The current findings highlight the importance of individual participant baseline neuropsychological testing for individuals on the autism spectrum.

Minimal Detectable Change for the ImPACT Subtests at Baseline.

To establish the minimal detectable change (MDC) of the subtests that comprise the composite scores from remotely administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baselines. Remote ImPACT baseline data from 172 (male = 45, female = 127) National Collegiate Athletic Association Division I student-athletes from the 2020 and 2021 athletic preseasons were used to calculate the MDC at the 95%, 90%, and 80% confidence intervals (CIs) for all subtest scores used to generate the four core composite scores and the impulse control composite. The MDCs for the verbal memory subtests at the 95% CI were 10.31 for word memory percent correct, 4.68 for symbol match total correct hidden, and 18.25 for three letters percentage correct. Visual memory subtest MDCs were 19.03 for design memory total percent correct and 4.90 for XO total correct memory. Visual motor speed subtest MDCs were 18.89 for XO total correct interference and 5.40 for three letters average counted correctly. Reaction time (RT) MDCs were 0.12 for XO average correct, 0.95 for symbol match average correct RT, and 0.28 for color match average correct. Impulse control MDCs were 5.97 for XO total incorrect and 1.15 for color match total commissions. One-way repeated measures MANOVA, repeated measures ANOVAs, and Wilcoxon signed-ranks test all suggested no significant difference between any subtests across two remote ImPACT baselines. The ImPACT subtest scores did not significantly change between athletic seasons. Our study suggests the subtests be evaluated in conjunction with the composite scores to provide additional metrics for clinical interpretation.

Elevated Autoantibodies to the GluA1 Subunit of the AMPA Receptor in Blood Indicate Risk of Cognitive Impairment in Contact Sports Athletes, Irrespective of Concussion.

To address the need for objective tests of concussion in athletes, we conducted a prospective clinical study in National Collegiate Athletic Association athletes of the relationship between neurocognitive performance and blood levels of the GluA1 subunit of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor peptides and autoantibodies to GluA1. Specifically, we compared 44 contact sport athletes to 16 noncontact sport athletes, with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), as well as blood sample collection, before the start of the season and at the end of the season. Contact sport athletes exhibited significantly elevated serum GluA1 autoantibodies at the end of season, compared with preseason levels, irrespective of whether they sustained a concussion. Noncontact sport athletes showed no change in serum GluA1 autoantibodies, and neither group showed differences in GluA1 peptides. Amongst contact-sport athletes, the 'high GluA1 autoantibody group' (≥4 ng/mL) displayed impaired reaction time, a measure of cognitive impairment, while the 'low GluA1 autoantibody group' (<4 ng/mL) displayed normal reaction time. Our results reveal that contact sport athletes are at risk for developing cognitive impairment even without sustaining a diagnosed concussion and that serum GluA1 autoantibodies provide a blood-based biomarker of this risk. This could guide future studies on the differing susceptibility to cognitive impairment in contact sport athletes and facilitate efficient allocation of resources to contact sport athletes identified as having increased risk of developing cognitive impairment.

Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study.

The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6h of injury, 24-48h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale. Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24-48h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5-70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6-49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1-2.9; male athletes, mean = 4.1, 95% CI 1.5-10.9). Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.

12 Measuring effort on a continuum provides improved insight into concussion baseline cognitive assessments

Objective:Baseline assessment of cognitive performance is common practice under many concussion management protocols and is required for collegiate athletes by the NCAA. The purpose of baseline cognitive assessment is to understand an athlete’s individual uninjured cognitive performance, as opposed to using population normative data. This baseline can then serve as a reference point for recovery after concussion and can inform return-to-play decisions. However, multiple factors, including lack of effort, can contribute to misrepresentation of baseline results which raises concern for reliability during return-to-play decision-making. Measuring effort across a continuum, rather than as a dichotomous variable (good versus poor effort) may provide informative insight related to cognitive performance at baseline.Participants and Methods:Collegiate athletes (n = 231) completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) as part of their baseline pre-participation concussion evaluation. ImPACT creates composite scores of Verbal Memory, Visual Memory, Visual-Motor Speed, and Reaction Time. Baseline self-reported symptoms and total hours of sleep the night prior to testing are also collected through ImPACT. ImPACT has one embedded indicator within the program to assess effort, and research has identified an additional three embedded indicators. Athletes were also administered one stand-alone performance validity test, either the Medical Symptom Validity Test (n = 130) or the Rey Dot Counting Test (n = 101), to independently measure effort. Effort was estimated across a continuum (zero, one, two, or three or more failed effort indicators) with both stand-alone and embedded effort indicators. We evaluated the relationship between effort, symptoms, self-reported sleep, Reaction Time composite score and Visual-Motor Speed composite score using a linear regression model.Results:We found that 121 athletes passed all effort indicators, while 39 athletes failed only one effort indicator, 40 athletes failed two effort indicators, and 31 athletes failed three or four (three+) effort indicators. Self-reported symptoms and total hours of sleep were not related to effort, but Reaction Time and VisualMotor Speed composites were. Specifically, performance on the Visual-Motor Speed composite was significantly worse for athletes who failed two or three+ effort indicators compared to athletes who did not fail any, and performance on the Reaction Time composite was significantly worse only for athletes who failed three+ effort indicators. Additionally, athletes who failed one or more effort indicators and reported less sleep performed worse on both the Visual-Motor Speed and Reaction Time composites, compared to those who reported less sleep and did not fail any effort indicators.Conclusions:Athletes who failed one effort indicator did not perform significantly worse on Reaction Time and Visual-Motor Speed composites compared to those who passed all effort indicators. However, 31% of athletes failed two or more effort indicators and these athletes performed worse on cognitive tests, likely due to factors impacting their ability to put forth good effort. These results suggest that effort is more complex than a previously used dichotomous variable and highlights the importance of using several indicators of effort throughout baseline assessments. In addition, the importance of sleep should be emphasized during baseline assessments, especially when effort is questionable.

52 Developing and Calibrating a Sex-Specific Psychiatric Screener within the Post-Concussion Symptom Scale

Objective:Pre- and post-morbid mental health conditions can prolong recovery from concussion and are generally detrimental to athletic performance and quality of life. If psychiatric conditions can be identified in athletes at the time of baseline testing, psychological/psychiatric intervention can be implemented to prevent these complications. Given the time constraints on neuropsychological baseline testing, it is important to have time-efficient screening measures. As such, the purpose of this study was to develop and calibrate a psychiatric screening measure within the Post-Concussion Symptom Scale (PCSS) from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), which is commonly administered to athletes at baseline, thereby “killing two birds with one stone”: (1) screening for psychiatric conditions and (2) obtaining a baseline measurement of concussion-like symptoms.Participants and Methods:Participants were 278 undergraduate students from a Canadian university with a mean age of 21.87 years (SD=4.87, range=18 to 52) and a sex composition of 64% females (n=179, Age: M=21.29 years-old, SD=4.34, range: 18 to 52) and 36% males (n=179, Age: M=22.93 years-old, SD=5.57, range: 18 to 50). Participants were a convenience sample collected via online survey platform in exchange for bonus points toward courses through a participant pool system between January and July 2021. The psychiatric screener consisted of the affective subscale from the PCSS (irritability, sadness, feeling more emotional, nervousness) and the criterion measure was the Depression, Anxiety, and Stress Scales (DASS-42). Statistical analyses were conducted in R v.4.3 and included confirmatory factor analysis and receiver operating characteristic (ROC) curve analyses. Although a balance was sought between sensitivity and specificity, the former was prioritized given that this is intended as a screening measure. Males and females were analyzed separately as females tend to report more symptoms than males. Mild, moderate, and severe elevations were predicted for depression, anxiety, and stress, based on standard DASS cutoffs.Results:The CFA analyses revealed good fit for both the PCSS (CFI=.992; TLI=.991; RMSEA=.053; SRMR=.066) and DASS (CFI=.995; TLI=.995; RMSEA=.053; SRMR=.065) models. Cutoffs of &gt;3, &gt;4, and &gt;8 (SENS= .77-.80, SPEC= .52-.83) optimally classified males as having mild, moderate, and severe depression, respectively; and cutoffs of &gt;8, &gt;8, and &gt;9 (SENS= .79-.83, SPEC= .63-.67) optimally classified females as having mild, moderate, and severe depression, respectively. A cutoff of &gt;2 (SENS= .78-.81, SPEC= .35-.39) optimally classified males as having both mild and moderate anxiety (insufficient n in severe group); and &gt;7, &gt;8, and &gt;9 (SENS= .80-.85, SPEC= .63-.68) optimally classified females as having mild, moderate, and severe anxiety. Cutoffs of &gt;5and &gt;8(SENS= .80-.86, SPEC= .70-.85) were optimal for detecting mild and moderate stress in males (insufficient n in severe group); and &gt;8, &gt;8, and &gt;9 (SENS= .80.89, SPEC= .60-.75) were optimal in females.Conclusions:The affective subscale within the PCSS operates well as a psychiatric screening measure. In general, females had higher cutoffs and the cutoffs for mild and moderate levels of the conditions tended to be similar. Males were less onsistent, with cutoffs varying widely depending on the construct and severity.

Do Differences Exist in Impact Test Domains between Youth Athletes with and without an Anterior Cruciate Ligament Injury?

Poor baseline reaction time, as measured via the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), has been associated with anterior cruciate ligament (ACL) injury risk in adult athletes. Our study sought to determine whether the reaction time and impulse control ImPACT test domains differed between ACL injured and uninjured pediatric athletes. A total of 140 high-school aged athletes comprising 70 athletes who went on to sustain an ACL injury between 2012 and 2018 and 70 age- and sex-matched uninjured controls were included in the study. Mean reaction times were similar for the injured (0.67 s) and uninjured (0.66 s) athletes (p = 0.432), and the impulse control scores were also similar for those with (5.67) and without (6.07) an ACL injury (p = 0.611). Therefore, neurocognitive risk factors for sustaining an ACL injury in adults cannot necessarily be extrapolated to adolescent athletes. Further research is needed to understand why differences exist between injury risk in youth and adult athletes.

Baseline ImPACT Composite Scores in Student-Athletes With Attention-Deficit/Hyperactivity Disorder.

Athletes who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of concussion compared to other athletes. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a widely used concussion tool, but it relies on pre-injury baseline testing that can be affected by psychiatric conditions. This research aims to determine if there are differences in pre-injury testing composite scores in student-athletes with ADHD compared to those without ADHD diagnosis. We obtained 11,563 pre-season ImPACT assessments of 7,454 student-athletes (ages: 12-22) from 2009 to 2019. After exclusions, there were 6,920 control and 276 ADHD subjects. Multivariable linear regression analyses compared the independent effect of ADHD on the six ImPACT composite score metrics with Bonferroni correction for multiple comparisons with a = 0.008. Univariate analyses indicated ADHD is associated with more symptoms as measured by the Post-Concussion Symptom Scale (PCSS) (β = 2.67, 95% CI: 1.47-3.87, p < .0001) and worse Impulse Control scores (β = 0.93, 95% CI: 0.33-1.53, p = .002). In multivariate analysis, this association was the same for symptom score (β = 2.48, 95% CI: 1.22-3.74, p < .0001), but Impulse Control was not significantly different after multiple comparison adjustment (β = 0.87, 95% CI: 0.22-1.15, p = .009). The ADHD subjects reported worse symptoms at baseline and had worse Impulse Control in univariate analysis, but not multivariate analysis. These results can further guide clinicians in concussion diagnosis and test interpretations for student-athletes with ADHD, considering the symptom burden at baseline.

A-47 Vestibular Symptoms and Recovery Time in Sport-Related Concussions among Collegiate Athletes

Abstract Purpose This study represents the initial phase in testing self-reported vestibular symptoms as potential predictive factors of protracted concussion recovery times among collegiate athletes. Methods Vestibular Symptoms Scale–Short Form (VSS-SF) was administered to 24 collegiate athletes (12 females, 12 males; ages=18-21) at baseline and post-injury. Participant data was grouped by number of days until symptom resolution post-concussion (1-10 days [N=13], 11-60 days [N=11]) and VSS-SF discrepancy scores (d-scores). To calculate d-scores, baseline scores were subtracted from post-injury scores for each athlete. Instances in which baseline scores were higher than post-injury were assigned a discrepancy score of 0. Concussion symptoms were documented using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Sport Concussion Assessment Tool, 5th Edition (SCAT-5). Results Results from an independent samples t-test demonstrated that VSS-SF d-scores were significantly higher among athletes with 11+ post-concussive recovery days (M=9.64, SD=10.21) compared to those with 1-10 recovery days (M=2.92, SD=3.77), t(22)=2.21, p=.019). Additionally, a simple regression revealed that d-scores significantly predicted recovery time and explained 23.9% of the variance (b=.44, R2=.24, p=.015). Interaction and mediation results will be presented and discussed. Conclusions Results suggest that changes in VSS-SF pre- and post-concussion can differentiate athletes with relatively short versus longer recovery time and predict length of concussion recovery. Further research with a larger number of participants appears warranted.

A-48 Comparative Analysis of Adolescents With a Sport-Related Concussion Versus Non-Sport-Related Concussion During Initial Visit

Abstract [Outstanding Trainee Award Winner] Purpose To investigate differences in pre-injury risk factors and clinical outcomes in adolescents with a Sport-Related Concussion (SRC) versus non-Sport-Related Concussion (non-SRC). Methods Participants (n=136, aged 10-18) presented to a specialty concussion clinic 2-30 (M=9.25) days post-injury. They completed a clinical interview with a trained clinician and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profile Screening (CP Screen), Vestibular/Ocular-Motor Screening (VOMS), Screen for Child Related Anxiety Disorders - Child Version (SCARED-C), and the Generalized Anxiety Disorder Assessment (GAD-7). Data analyses utilized independent sample t-tests, chi-square tests, and descriptive statistics to compare clinical outcomes of both groups during initial visit. Alpha was set to p&amp;lt;.05 for all analyses. Results Adolescents with non-SRC took longer to seek specialty concussion care, were majority female, and were older than the SRC group. Non-SRC participants also reported a higher rate of migraine, depression, and anxiety history (i.e., SCARED-C Panic Disorder, SCARED-C Generalized Anxiety Disorder, and SCARED-C Anxiety Disorder). Additionally, non-SRC participants reported more symptoms on the PCSS Total score, and on most VOMS items, including Smooth Pursuits, Horizontal and Vertical Saccades, Horizontal and Vertical Vestibular-Ocular Reflex, Visual Motion Sensitivity, as well as VOMS Total. Non-SRC group also reported higher post-injury anxiety scores (i.e., GAD-7). All findings were below the p-value of .05. Conclusions The study findings suggest that mechanism of injury and individual risk factors play a significant role in determining the clinical presentation of a concussion in an SRC and non-SRC adolescent population.