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Determining Sport Concussion Assessment Tool fifth Edition (SCAT5) reliable change in male professional hockey players
  1. Jared M Bruce1,
  2. Willem Meeuwisse2,
  3. Michael G Hutchison3,
  4. Paul Comper3,4,
  5. Ruben J Echemendia5,6
  1. 1Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
  2. 2Department of Player Health, National Hockey League, New York City, New York, USA
  3. 3Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
  4. 4Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
  5. 5Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
  6. 6Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
  1. Correspondence to Dr Jared M Bruce, Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; brucejm{at}


Objectives The purpose of this paper is to provide reliable change metrics and assess the test–retest psychometrics of the Sport Concussion Assessment Tool fifth Edition (SCAT5) in a multilingual sample of professional ice hockey players.

Methods The SCAT5 was administered to National Hockey League and American Hockey League male professional ice hockey players as part of the 2018 and 2019 season medical evaluations. We extracted data from an existing clinical database of players who were administered two consecutive baseline evaluations and had no intervening concussions to assess psychometric properties (eg, test–retest reliability) and develop reliable change metrics.

Results Overall, 1007 players met inclusion criteria. Players were reassessed on average 344.52 (±62.52) days following their first baseline. Test–retest reliability ranged from r=0.3 to r=0.5. Reliable change metrics for Immediate Memory varied considerably dependent on form order. Significant differences were found between English versus non-English language preference on Immediate Memory and Concentration but not Delayed Memory or the modified Balance Error Scoring System (mBESS). Reliable change indices at the 90% CI were: Symptom Severity (5), Total Symptoms (3), Immediate Memory (3-8), Concentration (2), mBESS (5) and Delayed Memory (2-4).

Conclusions Our findings highlight the importance of considering form differences and language preference when determining reliable change from baseline on the SCAT5 in male professional hockey players. The relatively modest test–retest reliability of the measures leaves room for improved psychometric properties and increased sensitivity to concussion in future iterations of the SCAT.

  • brain concussion
  • hockey

Data availability statement

No data are available. All applicable deidentified group data are presented in the text, tables and online supplemental tables. Individual player data are not available.

Statistics from

Data availability statement

No data are available. All applicable deidentified group data are presented in the text, tables and online supplemental tables. Individual player data are not available.

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  • Contributors RJE and JMB are guarantors assuming full responsibility for all aspects of this study including design, data acquisition, analysis and interpretation of the data, drafting and editing the manuscript, approval of the final version and submission. WM, MGH and PC contributed to the design of the project, data interpretation, manuscript review and editing, and final approval/responsibility of the document.

  • 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 cochair of the NHL/NHLPA Concussion Subcommittee. He is also a paid consultant for Major League Soccer and Princeton University Athletic Medicine. 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. WM is the Chief Medical Officer 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. PC is cochair of the NHL/NHLPA Concussion Subcommittee and a paid consultant to the NHLPA. JMB is a part-time employee of the NHL. JMB’s institution has received funding from Genzyme and EyeGuide supporting his work, and he has served as a paid consultant to Med-IQ and Sporting KC.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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