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BACKGROUND: Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). METHODS:An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. RESULTS:One hundred and thirty-five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return-to-learn protocol in place and 90% reported having a return-to-play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty-seven percent of respondents believed that PPM158 improves student well-being. CONCLUSIONS:Identified implementation barriers and facilitators can inform concussion policy practices to improve student well-being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools.

ObjectiveThe study examined whether cognitive functioning, history of concussion (HOC), and sex predicted risk of sport concussion.DesignRetrospective study design. Predictive models were used to determine the predictive ability of each variable.SettingCanadian University.Participants708 data observations from 701 varsity athletes (41.2% female), representing 14 sports.Assessment of risk factorsTwo measures of cognitive functioning (mean reaction time and throughput [speed and accuracy]) were assessed using the Automated Neuropsychological Assessment Metrics testing battery. Categorical and continuous measures of HOC, and sex, were examined.Outcome measuresOccurrence of concussion after baseline testing.Main resultsHOC was a significant predictor for both sexes. For every previous concussion, the odds of sustaining another concussion increased by 1.5 (95% Confidence Interval [CI]: 1.1, 2.1 [females]; 1.2, 1.9 [males]). Females with a HOC had twice the odds of sustaining another concussion than those without a HOC (CI: 1.1, 4.0). For males, the odds were three times (CI: 1.7, 5.6). Cognitive functioning and sex were not meaningful predictors.ConclusionsThis study supports previous findings that HOC is a risk factor and suggests that pre-injury cognitive functioning is not a risk factor for sport concussion. Assessing HOC in all athletes prior to their competitive season provides information regarding their risk of future sport concussion. Thus, it is important for clinicians to record HOC, and to encourage athletes to report concussions to ensure an accurate HOC record. Pre-injury cognitive screening of athletes is not recommended for assessing risk of future concussion.Competing interests Sandhya Mylabathula, Lynda Mainwaring, and Michael Hutchison None. Doug Richards is the Medical Director at the MacIntosh Sports Medicine Clinic at the University of TorontoPaul Comper is a clinical neuropsychologist consultant with the NHLPA and a member of the Concussion Working Group, but neither were related to the current research