Evaluation of a Simple Test of Reaction Time for Baseline Concussion Testing in a Population of High School Athletes

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Objective:A common sequela of concussions is impaired reaction time. Computerized neurocognitive tests commonly measure reaction time. A simple clinical test for reaction time has been studied previously in college athletes; whether this test is valid and reliable when assessing younger athletes remains unknown. Our study examines the reliability and validity of this test in a population of high school athletes.Design:Cross-sectional study.Setting:Two American High Schools.Participants:High school athletes (N = 448) participating in American football or soccer during the academic years 2011 to 2012 and 2012 to 2013.Interventions:All study participants completed a computerized baseline neurocognitive assessment that included a measure of reaction time (RTcomp), in addition to a clinical measure of reaction time that assessed how far a standard measuring device would fall prior to the athlete catching it (RTclin).Main Outcome Measures:Validity was assessed by determining the correlation between RTclin and RTcomp. Reliability was assessed by measuring the intraclass correlation coefficients (ICCs) between the repeated measures of RTclin and RTcomp taken 1 year apart.Results:In the first year of study, RTclin and RTcomp were positively but weakly correlated (rs = 0.229, P < 0.001). In the second year, there was no significant correlation between RTclin and RTcomp (rs = 0.084, P = 0.084). Both RTclin [ICC = 0.608; 95% confidence interval (CI), 0.434-0.728] and RTcomp (ICC = 0.691; 95% CI, 0.554-0.786) had marginal reliability.Conclusions:In a population of high school athletes, RTclin had poor validity when compared with RTcomp as a standard. Both RTclin and RTcomp had marginal test-retest reliability. Before considering the clinical use of RTclin in the assessment of sport-related concussions sustained by high school athletes, the factors affecting reliability and validity should be investigated further.Clinical Relevance:Reaction time impairment commonly results from concussion and is among the most clinically important measures of the condition. The device evaluated in this study has previously been investigated as a reaction time measure in college athletes. This study investigates the clinical generalizability of the device in a younger population.Video Abstract:A video abstract showing how the RTclin device is used in practice is available as Supplemetal Digital Content 1, http://links.lww.com/JSM/A43.

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