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Test–Retest Reliability of Concussion Baseline Assessments in United States Service Academy Cadets: A Report from the National Collegiate Athletic Association (NCAA)–Department of Defense (DoD) CARE Consortium

Published online by Cambridge University Press:  16 June 2020

Megan N. Houston*
John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, NY10996, USA
Kathryn L. Van Pelt
University of Kentucky, Lexington, KY40526, USA
Christopher D’Lauro
United States Air Force Academy, Colorado Springs, CO80840, USA
Rachel M. Brodeur
United States Coast Guard Academy, New London, CT06320, USA
Darren E. Campbell
Logan Regional Orthopedics, Logan, UT84341, USA
Gerald T. McGinty
United States Air Force Academy, Colorado Springs, CO80840, USA
Jonathan C. Jackson
United States Air Force Academy, Colorado Springs, CO80840, USA
Tim F. Kelly
United States Military Academy, West Point, NY10996, USA
Karen Y. Peck
United States Military Academy, West Point, NY10996, USA
Steven J. Svoboda
MedStar Orthopaedic Institute, Washington, DC20036, USA
Thomas W. McAllister
Department of Psychiatry, Indiana University, Indianapolis, IN46202, USA
Michael A. McCrea
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI53226, USA
Steven P. Broglio
Michigan Concussion Center, University of Michigan, Ann Arbor, MI48109, USA
Kenneth L. Cameron
John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, NY10996, USA
*Correspondence and reprint requests to: Megan N. Houston, John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, 900 Washington Road, West Point, NY10996, USA. Tel: +1 845 938 6826. E-mail:



In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test–retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.


All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.


ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.


This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.

Regular Research
Copyright © INS. Published by Cambridge University Press, 2020

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