We have known for some time that the ImPACT test is more accurate the older that a patient gets, primarily because the brain is still maturing and developing at younger ages. Consequently, Abeare and colleagues’ findings are not surprising, and provide a nice retrospective analysis of the data of failures among age groups and the validity indicators.
There are other tools that primary care physicians can use besides ImPACT to evaluate patients who have concussions to determine their ability to resume physical activity. These tools include return-to-play and return-to-school guidelines that some school districts have that PCPs can follow. PCPs can perform physical exams such as balance testing, vestibular and ocular responses to different challenges in addition to checking the cervical spine to see if muscular spasms are causing concussion-related symptoms.
PCPs can also put patients through a return-to-physical activity progression, which is part of the international return-to-play guidelines. This progression typically takes 5 to 6 days, for example, in daily sequential order for 20 minutes: biking, running, performing a sports-specific activity, weightlifting, noncontact practice, and then, finally, a contact practice if it’s a contact-collision athlete. If an athlete can perform all of these steps without exhibiting concussion symptoms, he or she can return to play. There is the neurocognitive testing as well, but PCPs need to know that the younger a patient is, the less valid the results may be.
Douglas Comeau, DO, CAQSM, FAAFP
Assistant professor, family medicine at Boston University School of Medicine,
Medical director, Boston University and Boston Medical Center Sports Medicine
Director, Boston University Sports Medicine Fellowship
Disclosures: Comeau reports no relevant financial disclosures.