Neuropsychological Testing in Sports Concussion Management: An Evidence-Based Model when Baseline Is Unavailable

Since Barth and colleagues’ seminal study used baseline neuropsychological testing as a model for sports concussion management, many collegiate sports medicine programs have adopted variations of their approach. However, no evidence-based strategy has yet been clearly articulated for the use of neuropsychological tests in concussion management that involves consideration of cases in which no baseline testing has been conducted. In this chapter, we articulate an evidence-based model for neuropsychological sports concussion management in collegiate athletes for cases in which baseline data are not available. The model involves an algorithm that is based upon base rates of impairment in a typical neurocognitive sports concussion battery, with decision rules that differ slightly for males and females. Although we use our population of collegiate athletes and the tests we administer as a framework to provide concrete values to the proposed algorithm, our evidence-based model could easily be applied to other sports concussion populations and neurocognitive test batteries. Our proposed neuropsychological concussion management guidelines provide an evidence-based model, while at the same time remain consistent with trends in the literature, suggesting that increasingly individualistic clinical concussion management approaches are most prudent.