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The utility of individual baseline versus normative reference values for the scat3 following concussion in professional ice hockey players
  1. Timo Hänninen1,
  2. Jari Parkkari1,
  3. Markku Tuominen2,
  4. Grant L Iverson3,4,5,
  5. Matti Vartiainen6,
  6. Juha Öhman7,
  7. Teemu M Luoto7
  1. 1Tampere Research Centre of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
  2. 2International Ice Hockey Federation (IIHF)/Medical Committee; Finnish Ice Hockey Association; Medisport Inc, Tampere, Finland
  3. 3Harvard Medical School, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation; Boston, Massachusetts, USA
  4. 4Massachusetts General Hospital for Children Sport Concussion Program; Boston, Massachusetts, USA
  5. 5Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
  6. 6Institute of Behavioural Sciences, Division of Cognitive Psychology and Neuropsychology, University of Helsinki, Helsinki, Finland
  7. 7Department of Neurosurgery, Tampere University Hospital, Tampere, Finland


Objective To characterise whether individual SCAT3 baseline scores are more useful than normative reference values following acute concussion.

Design Prospective cohort.

Setting Finnish professional male ice hockey league.

Participants SCAT3 baseline testing has been mandatory in the league since 2013. The league recommends day of injury testing for all players with suspected concussion. Of the reported day of injury SCAT3s, between seasons 2013–2016, a total of 29 concussions were confirmed by the teams’ medical staff.

Outcome measures Measures included: the individual baseline and day of concussion scores of the injured players; The league’s normative reference values [based on 2013–2014 preseason baselines (n=304)]; and the limits of normal variation on SCAT3 [based on league’s preseason baselines 2013–2014 and 2014–2015 (n=179)]. The post-injury performance was ruled as abnormal if (i) the player scored within the worst 10th percentile of the normative reference values or (ii) the score differed from the player’s own baseline more than the cut offs for 90% normal variation.

Main results The percentages of the players who performed abnormally on post-concussion testing (scores compared to individual baseline vs. normative reference values) were as follows: Symptoms: 96% vs. 100%; SAC: 31% vs. 22%; M-BESS: 50% vs. 50%; Tandem gait: 18% vs. 29%; Coordination: 7% vs. 7%.

Conclusions Post-concussion testing conducted with individual baseline seems to be as sensitive as assessment compared to normative reference values in acute concussion recognition. Symptoms were the most sensitive SCAT3 component.

Competing interests Timo Hnninen, Markku Tuominen, Jari Parkkari, Matti Vartiainen, Juha hman, Teemu M. Luoto: None.

Grant L. Iverson has been reimbursed by the government, professional scientific bodies, and commercial organisations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has not received research support from a test publishing company in the past 5 years.

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