Context: Version 5 of the Sport Concussion Assessment Tool (SCAT5) was released in 2017 with an additional 10-word list option in the memory section and additional instructions for completing the symptom scale.Objective: To provide reference scores for high school rugby union players on the SCAT5, including immediate memory using the 10-word list, and examine how age, sex, and concussion history affected performance.Design: Cross-sectional study. Setting: Calgary, Alberta high schools.Patients or Other Participants: High school rugby union players (ages 15-18 years) participating in a 2018 season cohort study (n ¼ 380, males ¼ 210, females ¼ 170).Main Outcome Measure(s): Sport Concussion Assessment Tool 5 scores, including total number of symptoms (of 20), symptom severity (of 132), 10-word immediate memory (of 30), delayed memory (of 10), modified Standardized Assessment of Concussion (of 50), and balance examination (of 30).Results: The median number of symptoms reported at baseline ranged from 5 to 8 across sex and age stratifications. Median symptom severity was lowest in males with no concussion history (7; range, 0-28) and highest in females with a concussion history (13, range ¼ 0-45). Median total scores on immediate memory were 2-3 (range ¼ 0-4) for males and 21 (range ¼ 9-29) for females. Median total scores were 3 (range ¼ 0-4) on digits backward and 7 (range ¼ 0-20) on delayed memory (all groups). Based on simultaneous quantile (q) regression at 0.50 and 0.75, adjusted for age and concussion history, being female was associated with a higher total symptoms score (q0.75 b female ¼ 2.85; 99% confidence interval [CI] ¼ 0.33, 5.37), higher total symptom severity score (q0.75 b female ¼ 8.00; 99% CI ¼ 2.83, 13.17), and lower number of errors on the balance examination (q0.75 b female ¼ À3.00; 99% CI ¼ À4.85, À1.15). Age and concussion history were not associated with any summary measures.Conclusions: The 10-word list option in the memory section reduced the likelihood of a ceiling effect. A player's sex may be an important consideration when interpreting the SCAT5 after concussion.Despite changes to the instructions for the baseline symptoms assessment, the majority of high school rugby players reported symptoms at baseline. Addition of the 10-word list to version 5 of the Sport Concussion Assessment Tool eliminated a ceiling effect for memory scores in high school rugby players. This study informs the use and interpretation of the Sport Concussion Assessment Tool, version 5, in Alberta high school rugby players and indicates that reporting of symptoms is normal at baseline in this age group.

Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP). Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3). Results: The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery. Conclusion: Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.