UPMC Speaks! Concussion Recovery Predictor Has ‘No Traditional Control Group,’ Flack Admits

The University of Pittsburgh Medical Center’s media relations department never responds to my inquiries, and that hurts my feelings. Peer-reviewed studies show that I get between 30.07 and 43.24 percent madder than baseline every time UPMC flacks ignore me.

However, the indefatigable Dustin Fink of the Concussion Blog yesterday did receive an unsolicited email from Chuck Finder, who joined the UPMC staff recently after years as a sportswriter for the Pittsburgh Post-Gazette. (And no mean jokes here about journos’ revolving door into PR – promise!)

Last week Fink wrote an unflattering analysis of UPMC’s hype of its new “concussion recovery predictor” model. (See http://theconcussionblog.com/2012/02/29/upmc-and-recovery-predictor/. Also see my own February 28 post “UPMC Cranks Up Concussion Cure Quack Quotient …,” https://concussioninc.net/?p=5346.)

Whereupon Finder contacted Fink. At the bottom of this post, as a public service, I reproduce Finder’s entire message, including the memo from UPMC’s Brian Lau responding to Fink’s questions.

On his blog today, Fink continues the discussion, and I advise everyone to read it: http://theconcussionblog.com/2012/03/06/upmc-responds-to-tcb-questions/. Dustin, a certified athletic trainer whose clinical knowledge far surpasses mine, is always a good source for critical reading and parsing of new traumatic brain injury publications and claims.

As a duly confident journalistic generalist, I reduce my own reading of UPMC’s defense to the following two points:

• In Nos. 1 and 5 below, UPMC’s Lau asserts that symptoms such as fatigue and headache can exist without concussions and are sometimes confused with them. Of course, the same point makes the “sensitivity” percentage claims for the ImPACT system — to the hundredths of a percent! — meaningless. We have no way of knowing if concussion symptoms are abating or if mere “concussion-like symptoms” are abating. I mean, two can play this circular logic game.

• In No. 4, UPMC explains that its recovery-predictor study has no “traditional control group.” English translation: There is no control group.

Irv Muchnick

Concussion Inc.’s ebook UPMC: Concussion Scandal Ground Zero is available on Amazon Kindle athttp://amzn.to/A0Hq2g, or as a PDF file by sending $1.49 via PayPal to paypal@muchnick.net.

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Dustin,
First, please allow me to introduce myself. My name is Chuck Finder, and in my previous life as a sports writer I penned more than a few concussion stories/series in my 25 years at the Pittsburgh Post-Gazette. I joined UPMC in mid-January to help represent their Sports Medicine and Concussion Program work.
Folks here noticed your Feb. 29 blog questions prompted by their Cut-Off Study news release, and Brian Lau — one of the co-investigators — typed up answers for you.
Use them however you choose: They can be for your edification solely or, if you wish, you have UPMC’s approval to post them as they are.
(Sorry for the delay, but Lau is in San Francisco and in the process of moving cross-country. So his schedule wasn’t exactly wide open.)
If you have any questions or need further follow-up, please don’t hesitate to ask me.
Thanks, and all the best,
Chuck Finder
UPMC Media Relations

*****

[BRIAN LAU MEMO]

1. Why would you neurocognitive test anyone with symptoms, while still recovering?
   1. The symptoms after a concussion — fatigue, headache, etc. — are non-specific findings that may or may not represent a concussion. Moreover, some athletes have some of these same symptoms at baseline. Neurocognitive testing has traditionally been used to determine the presence or absence of a concussion. This study adds to other preliminary evidence that neurocognitive testing while an athlete has symptoms during recovery may also assist in predicting length of recovery. A previous study showed that symptoms used alone had a 40.81% sensitivity in predicting protracted recovery. When neurocognitive testing was used with symptoms, the sensitivity in predicting protracted recovery increased to 65.22%.
   2. Are the numbers based upon the ImPACT “norms” or a baseline calculation?
      1. There are no numbers in this study requiring the use of norms or baseline calculations. We used the numbers from the first ImPACT tests and determined cutoffs off that.
      2. Is this experiment repeatable with other measures?
         1. This is the first study to attempt to set cut-offs for prognosticating return to play early after injury. As recommended in the discussion section, we hope that this study encourages other groups to conduct similar studies to evaluate the value of cut-off scores.
         2. Where are the control groups?
            1. It should be noted that this was an observational study that followed athletes, whom underwent a structured recovery program. It was not designed to compare two different diagnostic modalities or treatment intervention. Therefore, the traditional control group vs. study group that compares traditional practice with a novel diagnostic tool or treatment is not represented in this study. However, recovery from a sports concussion usually takes less than 14 days. In this study, the athletes were divided into protracted and short-recovery based on this time frame. As such, the short-recovery group may be considered the control group because it represents the natural recovery time following a sports concussion.
            2. Is the accuracy of ImPACT that sensitive (is there even one accurate enough to make this assessment)?
               1. ImPACT testing has been shown previously to have a high degree of sensitivity (81.9%) and specificity (89.4%) in diagnosing concussions (Shatz et al., Arch Clin Neuropsychol, 2006). The sensitivity and specificity in prognosticating the recovery time following a concussion has only recently been studied. A recent study showed that when ImPACT testing and symptoms were evaluated together, there was a sensitivity and specificity of 65.22 and 80.36%, respectively. The effectiveness of ImPACT testing as a prognosticating tool should be further validated and we hope that this study will encourage others to do so.
               2. What did each individual do for management of the concussion in the two days?
                  1. All athletes were followed by certified athletic trainers whom made the initial on-field diagnosis of a concussion. These certified athletic trainers were also trained in the graded extertional activity protocol used in this study which requires athletes to be symptom free at rest and to be cleared by clinical concussion specialists. Therefore, in the time frame prior to initial neurocognitive testing (mean: two days), athletes were kept out of practice and game situations.