Baseline Testing: Useful, But Not the Gold Standard
By Jason M. Matuszak, MD, FAAFP, FAMSSM
Baseline Sports & Performance Medicine
Every concussion is unique — and so is every athlete. That’s why baseline neurocognitive testing can be a helpful addition to a school’s or team’s concussion management program, but it’s not the foundation of one.
Over the years, many programs have invested in computer-based or sideline neurocognitive tests that measure memory, reaction time, and processing speed before a season starts. The idea is straightforward: if an athlete later suffers a concussion, their post-injury performance can be compared to their personal baseline to help guide recovery.
When used appropriately, these tools can offer valuable information. They can help track progress and support return-to-learn and return-to-play decisions. But it’s important to understand what they are — and what they aren’t.
Concussion Is a Clinical Diagnosis
Concussion remains a clinical diagnosis, not a test result.
No computer score, balance test, or eye-tracking system can replace a thorough evaluation by a clinician trained in concussion assessment.
A proper evaluation considers:
The mechanism of injury
Immediate and delayed symptoms
Neurologic and vestibular function
Cognitive performance
And most importantly — clinical judgment
That’s why the gold standard for concussion assessment is an in-person examination by a qualified healthcare professional, not any single testing tool.
Where Baseline Testing Helps
When integrated into a larger, evidence-based program, baseline testing can:
Establish a personalized reference point for post-injury comparison
Support individualized recovery decisions
Reinforce athlete education and awareness
Improve communication between athletes, coaches, and clinicians
For athletes with complex profiles — such as those with ADHD, learning disabilities, or prior concussions — baseline data can sometimes clarify whether post-injury results truly represent new changes.
Where Baseline Testing Falls Short
Baseline testing should never be used as a stand-alone clearance or diagnostic tool.
It has limitations:
Results can be influenced by effort, fatigue, or distraction
Test–retest reliability varies across platforms
Interpretation requires clinical context
False reassurance (a “normal” score despite ongoing symptoms) can delay recovery
In short: a good test helps guide decisions — it doesn’t make them.
The Right Way to Use Baseline Testing
Think of baseline testing as one piece of a comprehensive concussion management plan, not the plan itself.
That plan should include:
Preseason education for athletes, parents, and coaches
Clearly defined sideline recognition and removal protocols
A structured, clinician-supervised return-to-play process
Coordination between healthcare providers, athletic trainers, and schools
When these elements work together, athletes get the safest, most effective care possible — with or without baseline testing.
Final Thoughts
Baseline testing can be a valuable adjunct, especially when resources and trained personnel are available.
But the most important factor in concussion care is still the clinical expertise of the person performing the evaluation.
Technology can support decision-making — it just can’t replace clinical judgment.