Baseline neuropsychological testing in managing sport-related concussion: does it modify risk?

Baseline neuropsychological testing is mandated at various levels of play for hundreds of thousands of athletes each year. This paper reviews the risks associated with sport-related concussion, and the clinical validity and reliability data for the most commonly used baseline test, the ImPACT program. There is no evidence to suggest that the use of baseline testing alters any risk from sport-related concussion, nor is there even a good rationale as to how such tests might influence outcome. Given the poor sensitivity and low reliability of these measures, they have an associated high false negative rate (i.e., classifying a player's neurocognitive status is normal, when in fact, it is not). The use of baseline neuropsychological testing, therefore, is not likely to diminish risk, and to the extent that there is a risk associated with "premature" return-to-play, the use of these measures even may increase that risk in some cases.