Pre-Injury Measures do not Predict Future Concussion Among Collegiate Student-Athletes: Findings from the CARE Consortium

Am J Phys Med Rehabil - 2023

Lempke, L. B., Breedlove, K. M., Caccese, J. B., McCrea, M. A., McAllister, T. W., Broglio, S. P., Schmidt, J. D., Lynall, R. C., Buckley, T. A. and Investigators, C. C..



This prospective cohort study aimed to determine whether pre-injury characteristics and performance on baseline concussion assessments predicted future concussions among collegiate student-athletes. Participant cases (concussed = 2,529; control = 30,905) completed pre-injury: demographic forms (sport, concussion history, sex), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Balance Error Scoring System (BESS), Sport Concussion Assessment Tool (SCAT) symptom checklist, Standardized Assessment of Concussion (SAC), Brief Symptom Inventory-18 item (BSI-18), Wechsler Test of Adult Reading (WTAR), and Brief Sensation Seeking Scale (BSSS). We used machine-learning logistic regressions with area under the curve (AUC), sensitivity, and positive predictive values (+PV) statistics for univariable and multivariable analyses. Primary sport was determined to be the strongest univariable predictor (AUC = 64.3% +/- 1.4, sensitivity = 1.1% +/- 1.4, +PV = 4.9% +/- 6.5). The all-predictor multivariable model was the strongest (AUC = 68.3% +/- 1.6, sensitivity = 20.7% +/- 2.7, +PV = 16.5% +/- 2.0). Despite a robust sample size and novel analytical approaches, accurate concussion prediction was not achieved regardless of modeling complexity. The strongest +PV(16.5%) indicated only 17 out of every 100 individuals flagged would experience a concussion. These findings suggest pre-injury characteristics or baseline assessments have negligible utility for predicting subsequent concussion. Researchers, healthcare providers, and sporting organizations therefore should not use pre-injury characteristics or baseline assessments for future concussion risk identification at this time.

Links to full article: