Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 1: cross-cultural normative data

Abstract

ObjectivesThis 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.MethodsA 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.ResultsNo 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.ConclusionsSignificant 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.

Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 2: which components differentiate concussed and non-concussed players?

“…Specifically, the Concentration composite of the SCAT5 did not significantly differentiate Concussed athletes from Controls and had smaller effects than those obtained by the other behavioural performance measures. As noted in our prior work,15 this may be due in part to ceiling effects (see online supplementary tables S11,S12), particularly with regard to Months in Reverse. As such, eliminating or replacing Months in Reverse with another working memory task and increasing the number of digit strings in the Digit Backward subtest would make the tests more difficult, possibly increasing the instrument's sensitivity to concussion.…”

“…Players chose from eight different languages (English, Swedish, French, Russian, Czech, Finnish, Slovak or German) to endorse symptoms on the Post-Concussion Symptom Scale (PCSS). 15 The rest of the examination was administered in English. Lastly, countdown timers were added to all subtests requiring a timed component (eg, Delayed Recall, balance measures) and progression from one subtest to the next was dependent on completion of prior subtests.…”

“…No significant performance differences were found between paper administration and App administration as part of a large normative sample at baseline. 15…”

“…Data were extracted if the player was English-speaking and had valid baseline and acute SCAT5 evaluations (within 1 day of injury). Lastly, mBESS analyses were restricted to players tested without skates due to our work 15 showing marked ceiling effects on mBESS with players wearing skates. Figure 1 shows an inclusion flowchart for the study.…”

“…It is also important to reiterate that this analysis was conducted on a smaller sample of players, as many players were assessed acutely while wearing skates and could not be tested with the mBESS. 15 Future research should examine the independent value of the mBESS in sports that are more amenable to acute balance assessment in bare feet or conventional footwear.…”