UPMC and Recovery Predictor?


The University of Pittsburgh Medical Center and its concussion program have released what they think is a new model to predict how long each individual may take to recover.  Lead researcher on this topic is Dr. Micky Collins who stated in a press release that this information is a “game changer”.

The study involves the ImPACT neurocognitive testing platform (developed by UPMC) and its results two days after injury.  Although the actual score has not been released publicly; it will appear in the next issue of Neurosurgery.  The benefits of such a specific diagnostic indicator would be tremendous for a lot of interested parties.

At the end of the press release/story Dr. Collins indicated something that is similar to what we posted yesterday; “Eighty percent of concussed people recover inside of three weeks.”

This information is all well and good but I would like to speak to some initial “wait a second” thoughts I have regarding this study;

  1. Why would you neurocognitive test anyone with symptoms, while still recovering?
  2. Are the numbers based upon the ImPACT “norms” or a baseline calculation?
  3. Is this experiment repeatable with other measures?
  4. Where are the control groups?
  5. Is the accuracy of ImPACT that sensitive (is there even one accurate enough to make this assessment)?
  6. What did each individual do for management of the concussion in the two days?

I am merely stating that there are flaws with this that need to be shored up before anyone calls it a game changer.  I respect Dr. Collins, however, couldn’t you basically look at the symptom score at 2 days post and make a judgement on length of recovery?  Add to that the management of the injury; those kids that did the “cocoon-like” therapy were they the ones who showed quicker recovery, versus those kids that did not heed the advice of complete rest.

Although I am questioning this information, more like hold on a second, others are much more critical of UPMC and their so-called drivel, look no further than Irv Muchnick;

I hope Alan Schwarz, the baseball statistics nerd who used his arithmetical wizardry to bring the football helmet industry to its knees, will come out of retirement as The New York Times’ concussion beat reporter and engage the latest outlandish claims of the University of Pittsburgh Medical Center Sports Concussion Program.

The moral of the story make sure all information is gathered before making judgements…

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7 thoughts on “UPMC and Recovery Predictor?

  1. Jake Benford February 29, 2012 / 08:34

    One other “wait a second” thought:

    The ImPact test is not an easy test on the brain, even when you do not have symptoms. Taking a test like this 2 days after injury could actualy delay symptoms.

  2. Jason February 29, 2012 / 09:24

    my concern with this is I don’t test athletes who I know are concussed while they have noticeable symptoms (i.e. Usually within 2-3 days post injury) due to the test making symptoms a whole lot worse. I did this the first year we had ImPACT and the kids who took the test while symptomatic usually were out longer than the ones who were not noticeably symptomatic at test time.

    I guess I am saying if we tell a concussed athlete to avoid TV, video games, movie, etc due to prolonging wymptoms, is it right for us to put them through something that we know will exasterbate their symptoms? I say no. That is why I am skeptical of this.

  3. A Concerned Mom February 29, 2012 / 09:35

    Just some questions from a mom’s perspective … (1) Age – I believe ImPACT is only for ages 11 and above. I was told by my son’s doctors that age can influence the length of recovery, with younger children generally taking longer to recover (on average, for a similar injury, an 11 year-old would take longer to recover than a 17 year-old). I’m not certain how or if ImPACT results relate to the age of the test taker. (2) Vestibular system – does the ImPACT test factor in balance problems? (More generally, are there any concussion signs or symptoms that aren’t measured by ImPACT? Based on what doctors, such as Cantu, have said … I suspect there are.)

    • BryanATC February 29, 2012 / 22:24

      While I have heard reports that specific low scores in certain domains on ImPACT are good indicators of a prolonged recovery (can’t remember which ones specifically), I don’t believe ImPACT is at all sensitive enough to give an accurate idea of recovery time for all cases.

      With that being said, I think we are missing some variables here with regards to testing/not testing someone 48 hours after injury. For one, I’ve had several cases where recently (particularly basketball players who took charges) where their symptoms were entirely musculature related (kinda like the Kobe “whiplash”). While their symptom score was at 20+, they scored phenomenally well on their post-injury ImPACT and immediately had cessation of symptoms after having the musculature dysfunction addressed. Note, until the neurologist ordered an MRI of the neck musculature the athletes hadn’t even been complaining about neck pain because the headaches/dizziness/etc. had been “drowning” it out. Once that was addressed the athletes immediately indicated a dramatic drop in symptoms. Also know that all but one of these cases were with athletes who’s season were over so it was not a “want to get back to playing” healing moment.

      Again there are instances where concussion is a “given” (i.e. LOC) and there isn’t a need to rush back. Even so, is a 20 minute test really going to be a huge factor in someones prolonged recovery? Somehow I don’t think it would.

  4. Jake Benford March 1, 2012 / 09:21

    Bryan

    The case you describe is all too familiar. The diagnosis is not always clear, and that is where being a good clinician comes into play. We need to examine other possibilities for thier symptoms.

    As far as the 20 min test prolonging recovery. Think about it like this. Would you send a kid out to run a mile 2 days after a knee injury, just to help determine how long they were going to be out? Likely no. This would likley cause further inflamation and injury, and prolong the recovery. In the case of mTBI (concussion), the same inflamitory state exsits, and the ImPact test is like running a mile.

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