HQ BaselineEvidence review
The Great Baseline Debate: Does Pre-Season Concussion Testing Actually Help?
The most important and honest article we can write: there is genuine scientific disagreement — and you deserve to hear both sides.
This is the most important and honest article we can write: there is genuine scientific disagreement about whether baseline testing meaningfully improves concussion outcomes. And we think you deserve to hear both sides.
The case against
The case against is data-driven. The CARE Consortium — a massive collaborative research initiative between the NCAA and the U.S. Department of Defense — analyzed data from thousands of collegiate athletes and published their findings in the American Journal of Sports Medicine (Pandey et al., 2024). They found that individual baselines provided minimal additional diagnostic value over population normative data for the majority of athletes.
In other words, for a typical healthy athlete, knowing their specific pre-injury scores didn’t significantly change clinical decision-making compared to using age- and sex-matched population averages. This finding has been corroborated by other research, including work by Schmidt et al. published in the Journal of Athletic Training.
The case for
The case for is more nuanced. The National Athletic Trainers’ Association recommends universal baseline testing in their position statement on concussion management (Broglio et al., 2014), emphasizing that individual baselines are critical for athletes with pre-existing conditions — ADHD, learning disabilities, prior concussions, migraines, anxiety, depression, and autism spectrum disorder — whose “normal” falls outside population norms. Research by Covassin et al. (2017) in the Journal of Athletic Training confirmed that these preexisting factors significantly affect baseline scores. For these athletes — who may represent 20–30% of any team — normative data is insufficient.
The third argument
There’s also a third argument that transcends the diagnostic debate entirely. A 2024 qualitative study in the Journal of Science and Medicine in Sport(Salmon et al.) studied community rugby in New Zealand and found that the greatest value of baseline testing may be its “unintended consequences”:
- Creating education opportunities that players and coaches wouldn’t have otherwise received.
- Building concussion awareness across entire organizations.
- Improving perceptions of safety culture.
- Normalizing the act of reporting symptoms and disclosing injuries.
Our position
Baseline testing is most valuable for athletes with complicating factors, and it is valuable for all athletes as an educational and cultural tool. We believe the testing process itself — the conversation it starts, the awareness it builds, the data it creates — is worth the investment. But we also believe firmly that a bad baseline (poorly administered, invalid, or misinterpreted) can cause harm.
The answer isn’t whether to baseline — it’s whether to baseline well. For the practical corollary, read our piece on why invalid baselines can be worse than none.