Children's Hospital Colorado

Baseline Cognitive Testing in Young Athletes

A group of soccer player jump to head the ball.

Certain athletic programs require athletes to take a computerized baseline test before competing on a sport’s team. These tests evaluate the athlete’s cognitive functions to establish a baseline in the event of a concussion during the season. If an athlete is suspected of having a concussion during the season, a second test can be administered and compared to the baseline test. Unfortunately, these tests may not be as reliable or useful as originally thought.

Why is a baseline cognitive test used?

Theoretically, these tests are appealing because they have the potential to provide additional information about an athlete’s thinking, memory and response speed after a concussion. However, at present, the value of baseline testing remains scientifically questionable, especially for younger athletes.

What are the problems with baseline testing?

Some of the most popular computerized tests, such as ImPACT, have not been adequately investigated in children and have serious statistical problems in older athletes. One problem is extremely poor test-retest reliability. If the same athlete takes ImPACT on two occasions, even without sustaining a concussion, the results can differ considerably. This is not unlike using a thermometer that produces two different results when body temperature remains the same.

Additionally, these computerized tests have not been shown to be sensitive to concussion-related difficulties after the athlete is no longer reporting post-concussion symptoms (e.g., headache).

Can baseline testing prevent bad outcomes for my child?

Baseline testing is often marketed as being able to prevent bad outcomes, such as prolonged post-concussion symptoms or even death. However, research has not yet shown that it prevents any problems or improves any outcome for the young athlete. Simply, baseline testing has not been shown to reduce the known risks associated with returning athletes to play after concussion.

Do the benefits of testing outweigh the costs?

Computerized baseline and serial testing programs can be costly and time intensive for schools, athletic organizations, healthcare professionals and families. Some may argue that regardless of the costs and time associated with baseline testing, it “can’t hurt.” However, given the aggressive marketing behind many of these tests, the results are often times over-emphasized in clinical decision-making.

Clearly, given the poor statistical properties of tests like ImPACT, relying on the results can lead to athletes returning to a sport before they have fully recovered or being restricted from a sport unnecessarily when the athlete is back to normal and medically ready and safe to play.

Concussions are types of brain injuries and are very serious for a young athlete. Fortunately, most young athletes recover completely from a single sport-related concussion fairly quickly. It is important to recognize concussion symptoms immediately.

Read more about the Children’s Hospital Colorado Concussion Program.

Written by: Amy Connery, PsyD, ABPP, John Kirk, PsyD, ABPP, and Michael Kirkwood, PhD, ABPP