Evaluating the "threshold Theory": Can Head Impact Indicators Help?

Jason P. Mihalik, Robert C. Lynall, Erin B. Wasserman, Kevin M. Guskiewicz, Stephen W. Marshall

Research output: Contribution to journalArticle

  • 3 Citations

Abstract

Purpose This study aimed to determine the clinical utility of biomechanical head impact indicators by measuring the sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of multiple thresholds. Methods Head impact biomechanics (n = 283,348) from 185 football players in one Division I program were collected. A multidisciplinary clinical team independently made concussion diagnoses (n = 24). We dichotomized each impact using diagnosis (yes = 24, no = 283,324) and across a range of plausible impact indicator thresholds (10g increments beginning with a resultant linear head acceleration of 50g and ending with 120g). Results Some thresholds had adequate sensitivity, specificity, and PV-. All thresholds had low PV+, with the best recorded PV+ less than 0.4% when accounting for all head impacts sustained by our sample. Even when conservatively adjusting the frequency of diagnosed concussions by a factor of 5 to account for unreported/undiagnosed injuries, the PV+ of head impact indicators at any threshold was no greater than 1.94%. Conclusions Although specificity and PV- appear high, the low PV+ would generate many unnecessary evaluations if these indicators were the sole diagnostic criteria. The clinical diagnostic value of head impact indicators is considerably questioned by these data. Notwithstanding, valid sensor technologies continue to offer objective data that have been used to improve player safety and reduce injury risk.

LanguageEnglish (US)
Pages247-253
Number of pages7
JournalMedicine and Science in Sports and Exercise
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2017

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Head
Sensitivity and Specificity
Football
Craniocerebral Trauma
Biomechanical Phenomena
Technology
Safety
Wounds and Injuries

Keywords

  • BIOMECHANICS
  • BRAIN INJURY
  • CONCUSSION
  • SPORT INJURY

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Evaluating the "threshold Theory" : Can Head Impact Indicators Help? / Mihalik, Jason P.; Lynall, Robert C.; Wasserman, Erin B.; Guskiewicz, Kevin M.; Marshall, Stephen W.

In: Medicine and Science in Sports and Exercise, Vol. 49, No. 2, 01.02.2017, p. 247-253.

Research output: Contribution to journalArticle

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