Acknowledgements: This research would not have been possible without the support of Hockey Calgary, Hockey Alberta, Hockey Quebec, Hockey Canada, team therapists, team designates, coaches, players and parents. Conflicts of Interest and Source of Funding:No conflicts of interest are declared. We acknowledge the support of Max Bell

BackgroundPediatric concussion risk factor identification will facilitate targeted injury prevention strategy development.ObjectiveTo examine risk factors for concussion and prolonged recovery amongst elite youth ice hockey players.DesignCohort study.SettingCommunity ice rinks and sport medicine clinic (2011/12 season).ParticipantsMale and female elite Bantam (13–14 years) and Midget (15-17 years) ice hockey players (n=780).Assessment of risk factorsBaseline age group, sex, previous concussion history and SCAT2 component scores [Total Symptom Score (TSS), Balance Error Score (BES) and Standardized Assessment of Concussion (SAC) score] were evaluated.Main outcome measurementsPlayers with a suspected concussion were referred to a sport medicine physician by team therapists/trainers (n=137). Concussions with time loss of >10 days were defined as prolonged recovery.ResultsConcussion incidence rate ratios (IRR) were estimated using multivariate (concussion) and univariate (prolonged recovery) Poisson regression analyses (cluster and exposure hours adjusted). Males were at greater risk than females [IRR=1.44 (95% CI: 1.09–1.90)]. In females with no concussion history, Bantam players were at greater risk than Midget players [IRR=4.04 (95% CI: 1.24–13.19)]. In Midget players, those with a history of concussion were at greater risk than those with no concussion history [IRR=2.68 (95% CI: 1.61–4.46)]. Players with baseline TSS in the lowest 25th%ile were at greater risk of concussion [IRR=1.50 (95% CI: 1.03–2.18)] and prolonged recovery [IRR=1.88 (95% CI: 1.18–2.99)]. Players with a history of concussion were at increased risk for prolonged recovery [IRR=2.02 (95% CI: 1.29–3.16)]. SAC and BES were not risk factors.ConclusionsAge group, sex, previous concussion history, and baseline symptom reporting affected the risk of concussion and prolonged recovery in elite youth ice hockey players. This study will inform the development of youth sport concussion prevention strategies.

ObjectiveTo examine the risk of concussion amongst elite youth male and female ice hockey players.DesignProspective cohort study.SettingCommunity ice rinks and sport medicine clinics.Participants764 Bantam (12–14 years) and Midget (15–17 years) ice hockey players. Assessment of Risk Factors: 743 players completed baseline SCAT2 testing (2011/2012 season). Age group, sex, previous concussion history, Total Symptoms Score (TSS), Balance Error Score (BES), Standardised Assessment of Concussion (SAC) Score and SCAT2 Total Score at baseline were evaluated as potential risk factors. Higher scores indicate greater impairment or symptoms.Main Outcome MeasurementsPlayers with a suspected concussion were assessed by a team therapist and referred to a sport medicine physician.ResultsMultivariate Poisson Regression analyses, adjusted for cluster by team, were used to estimate concussion risk ratios (RR). The RR for Bantam players with previous concussion history was 1.15 (95% CI 0.69 to 1.90) and for Midget players with previous concussion history was 2.83 (95% CI 1.69 to 4.72) compared to players in the same age group with no previous concussion history. The RR for players with baseline TSS and SCAT2 Total Score in the lowest 25%ile were 1.54 (95% CI 1.07 to 2.20) and 1.40 (95% CI 1.03 to 1.90), respectively, compared to those in the upper 75%ile. Sex, BES and SAC score were not predictive of concussion.ConclusionsThere is a greater risk of concussion in elite ice hockey players 15–17 years old with a previous history of concussion. Baseline TSS and SCAT2 Total Score in the lowest 25%ile are also predictive of concussion.AcknowledgementsThe University of Calgary Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We also acknowledge the support of Alberta Innovates Health Solutions, the Alberta Children's Hospital Institute for Child and Maternal Health (Alberta Children's Hospital Foundation) and Talisman Energy for their generous support.

Objective To investigate differences between baseline self-report of concussion symptoms with two commonly used concussion assessment tools. Design Retrospective, cross-sectional. Setting University of Alberta. Subjects One hundred and ninety-four varsity athletes (117 males; 77 females). Intervention Prior to the competitive season, subjects completed baseline testing, including self-report of concussion symptoms, with the Subjective Concussion Assessment Tool (SCAT2) and the on-line computerised Immediate Post-Concussion Assessment of Cognition (ImPACT) test, under supervision of an athletic therapist. Testing was counterbalanced to control for serial position effect. Outcome Measures The 18 shared self-report concussion symptoms were compared, and a general linear model used to identify possible interactions between gender and group type (SCAT2 vs ImPACT). Finally correlations were calculated. Results There was an interaction between gender and group type for 1 symptom (trouble falling asleep). Surprisingly, pairwise comparisons identified differences (p≤ 0.05) on 10/18 paired symptoms, with correlations ranging from 0.08 to 0.58. Conclusions Subjects respond differently when self-reporting concussion symptoms, depending on type of instrument used, and mode of administration. Despite test items being similar in content, there are significant differences in symptom reports in the same subject between SCAT2 and ImPACT tests. Use of similar data collection methods for baseline testing, assessment post-injury and prior to return-to-play is indicated, to increase both the diagnostic and prognostic utility of such tests. This further emphasises current recommendations that these tests not be used in isolation to make therapeutic decisions regarding athletes with concussion; and underscores the importance of serial clinical evaluations by a suitably qualified physician. Competing interests None. All authors have signed the disclosure form.

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