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  1. K Taylor1,3,
  2. BL Brooks4,6,7,
  3. KJ Schneider1,4,
  4. TA Blake1,
  5. CD McKay1,
  6. WH Meeuwisse1,2,
  7. KM Barlow6,7,
  8. J Kang1,
  9. CA Emery1,4,5,6
  1. 1Sport Injury Prevention Research Centre, Faculty of Kinesiology University of Calgary, Calgary, Canada
  2. 2University of Calgary Sport Medicine Centre, University of Calgary, Calgary, Canada
  3. 3Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
  4. 4Alberta Children's Hospital Research Institute for Child & Maternal Health, Faculty of Medicine, University of Calgary, Calgary, Canada
  5. 5Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada
  6. 6Department of Pediatrics and Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Canada
  7. 7Pediatric Traumatic Brain Injury Rehabilitation and Research Program, Alberta Children's Hospital, Calgary, Canada


Background Neurocognitive recovery following sport-related concussion is important for re-injury risk reduction. In elite youth hockey, it is unknown if neurocognitive function returns to baseline values at the time of medical clearance to return to play (RTP).

Objective To determine if ImPACT composite scores have returned to baseline values at the time of medical clearance to RTP.

Design Prospective case series.

Setting Sport Medicine Clinics (Alberta, Canada).

Participants Concussed elite male and female youth (13–17 years) ice hockey players (n=68) and healthy controls (n=22) completed ImPACT and SCAT2 testing at baseline and RTP following concussion.

Main outcome measurements Team therapists/trainers referred concussed players to the study sport medicine physician. The physician determined RTP via symptom resolution and SCAT2 score normalization. Physicians were blinded to ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) composite scores (verbal memory, visual memory, reaction time and visual motor), which were used to evaluate neurocognitive performance.

Results Comparisons between baseline and RTP ImPACT scores were based on reliable change (RC) scores derived from a sample of healthy players tested twice at baseline within 2 weeks (RC scores with 90% CI: verbal memory +/−14; visual memory, +/−15; reaction time, +/−0.1; and visual motor, +/−8). All four ImPACT composite scores were normalized at RTP in 73.5% (95C% CI: 61.5–82.8) of concussed participants and all but one [95.5%; 95% CI:70.39–99.46) controls. In the concussed players, 25.0% (95% CI: 16.0–36.9) had 1 composite score not return to baseline at RTP. One player had three composite scores not return to baseline at RTP.

Conclusions Elite hockey players are often cleared for RTP without the benefit of knowing neurocognitive performance on ImPACT. In this cohort, 25% of concussed players who were cleared to return to hockey had 1 composite score that had not yet returned to baseline. These results may have implications for tertiary prevention.

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