BackgroundChildren and youth are at increased risk of sustaining sport-related concussions. There is a need to develop age-specific tools to evaluate the effects of concussion. The objective of this study was to determine normative values for the Child Sport Concussion Assessment Tool (Child SCAT3) in child athletes and evaluate the symptom scoring agreement between the child and parent.MethodsChild SCAT3 was administered to ice hockey players enrolled in a regional minor hockey association. Statistical analyses were performed to evaluate the differences between child and parent reporting as well as those based on age.Results227 athletes (7–12 years of age) completed the Child SCAT3. 29 players reported a history of concussion. For the objective components, the average total Standard Assessment of Concussion adapted to a child version (SAC-C) score of 24.4 was made up by orientation (3.7), immediate memory (12.9), concentration (3.8) and delayed recall (3.9) sections. Average errors in the modified Balance Error Scoring System (BESS) were 1.6, tandem gait time 14.9 s and coordination score 0.95. For the subjective component, children reported an average of eight symptoms and a severity of 11; parents reported seven symptoms with a severity of 9. Overall, children reported higher symptom severity in comparison with their parents. In addition, parents significantly underestimated both physical and sleep-related symptoms in comparison with the children's scores.ConclusionsResults provide representative scores for the Child SCAT3 in young male ice hockey players. Clinicians should be aware that parents tend to underestimate their child's symptoms and symptom severity, particularly in the domains of physical symptoms and sleep. Encouraging objective symptom documentation with sleep or pain diaries, for example, may be useful for reliable clinical assessment in this age group.

no points for improvement concerning the tools. Patients commented on the website, and changes were made accordingly. Discussion We developed a tailor-made strategy for PPH guideline implementation. The next step in the implementation process is to evaluate the feasibility of the strategy, including an effect, process and cost evaluation.

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Background Current practices in developing guidelines about the use of diagnostic tests and strategies (DTS) are out of step with the conceptual discussion among experts. Objectives Identify the essential factors to consider when making recommendations about DTS. Methods We conducted semi-structured in-depth interviews with experts in assessing evidence and producing guidelines about DTS. Results We interviewed 23 international experts. Although diagnostic test accuracy (DTA) was the factor most commonly considered by organisations when developing recommendations, experts agreed that DTA is never sufficient and may be misleading. Experts identified the following additional essential factors in making decisions about DTS: resource implications, complications, inconclusive results, additional benefits of the test, diagnostic/therapeutic impact, safety, feasibility, ethical, legal, and organisational considerations, patients' and societies' values and preferences and the link between the test results and patient important outcomes. Because direct evidence on DTS's effects on patient outcomes and resource implications is frequently unavailable, most experts agreed that decision analysis and mathematical modelling will be useful, but their opinion varied about the extent of details needed. Discussion Formal decision modelling can be a useful framework for organising the clinical, cost, and preference data relevant to the use of diagnostic tests. Although it requires resources, it is useful for integrating these factors into decision making, identifying evidence gaps, and high priority research areas. Implications Developing guidelines about the use of DTS requires considering factors beyond solely DTA but implementing this demand is challenging. Further development and testing of a framework that can guide this process is needed.