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Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 1: cross-cultural normative data
  1. Ruben J Echemendia1,2,
  2. Joanie Thelen3,4,
  3. Willem Meeuwisse5,
  4. Michael G Hutchison6,
  5. Paul Comper7,
  6. John Rizos8,
  7. Jared M Bruce9
  1. 1Psychology, University of Missouri - Kansas City, Kansas City, Missouri, USA
  2. 2Concussion Care Clinic, University Orthopedics Center, State College, Pennsylvania, USA
  3. 3National Hockey League, New York City, New York, USA
  4. 4University of Missouri Kansas City, Kansas City, Missouri, USA
  5. 5National Hockey League, Calgary, Alberta, Canada
  6. 6Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
  7. 7Toronto Rehabilitation Institute, Toronto, Ontario, Canada
  8. 8Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
  1. Correspondence to Dr Ruben J Echemendia, State College, Pennsylvania, USA; rechemendia{at}


Objectives This paper provides comprehensive normative data stratified by language preference and age on the components of the National Hockey League (NHL) Sport Concussion Assessment Tool 5 (SCAT5) in a multilingual sample of professional ice hockey players and compares the findings from a paper form of the NHL SCAT5 with an electronic (App) version of the tool.

Methods A total of 1924 male NHL and American Hockey League (AHL) players (ages 17–41) were assessed during preseason medical evaluations (baseline); 1881 were assessed with the NHL SCAT5 App via tablet and 43 received the paper version of the NHL Modified SCAT5.

Results No significant differences between the App and paper modes of administration emerged in a subsample of English preference players. Significant SCAT5 differences among language preference groups emerged on measures of cognitive functioning (Immediate Memory,Concentration). No language preference differences emerged on the Delayed Recall component. Using age as a continuous variable, older participants outperformed younger players on Immediate Memory, Delayed Recall and Concentration. Players wearing skates demonstrated significantly more modified Balance Error Scoring System (mBESS) total errors than barefoot players. Normative data tables for language preference groups are presented.

Conclusions Significant differences were found between English and non-English language preference groups on the components of SCAT5, which suggest that language-specific normative data, rather than aggregated normative data, are preferable when interpreting test scores. Similarly, age-specific normative data tables may provide greater precision in data interpretation. Due to clear ceiling effects on the mBESS single leg and tandem stances, players should not be tested while wearing skates.

  • concussion
  • diagnosis
  • evaluation
  • hockey
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  • Contributors RJE and JMB assumed full responsibility for all aspects of this study, including design, data acquisition, analysis and interpretation of data, drafting and editing the manuscript, and approval of the final version and submission. JT, WM, MGH, JR and PC contributed to the design of the project, data interpretation, manuscript review and editing, and final approval/responsibility for the document. WM, PC, JR and MGH assisted in designing the study, edited and critically reviewed the manuscript, and approved the final version of the manuscript. JT assisted in drafting the manuscript and in data management, edited and critically reviewed the manuscript, and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RJE is a paid consultant for the NHL and co-chair of the NHL/NHLPA Concussion Subcommittee. He is also a paid consultant for Major League Soccer and Princeton University Athletic Medicine. He has a financial interest in EyeGuide and is chair of their Scientific Advisory Board. He is currently a co-PI for a grant funded by the NFL (NFL-Long) through Boston Children’s Hospital and occasionally provides expert testimony in matters related to MTBI and sports concussion. JT is a part-time employee of the NHL. WM is Medical Director for the NHL and an employee of the NHL. MGH is a member of the NHL/NHLPA Concussion Subcommittee and a consultant to the NHLPA, for which he receives remuneration. JR is a member of the NHL/NHLPA Concussion Subcommittee and a paid medical/physician consultant to the NHLPA. PC is co-chair of the NHL/NHLPA Concussion Subcommittee and a paid consultant to the NHLPA. JMB is a part-time employee of the NHL. He receives grant funding from Genzyme and is a consultant to Med-IQ and Sporting KC.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study has been approved by the University of Missouri-Kansas City Office of Research Compliance (FWA #00005427).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All applicable deidentified group data are presented in the text, tables and supplemental tables. Individual player data are not available.

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