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Objective This study was designed to determine concussion incidence, risk, and relative risk among middle and high school athletes participating in various sports. Method Data were retrospectively obtained from 10,334 athletes of 12 different sports in Hawaii. In addition to determining the overall concussion incidence, comparisons of incidence, risk, and relative risk were made according to age, sex, concussion history, sport, and football position. Results The overall incidence of concussion among youth athletes was 1,250 (12.1%). The relative risk for a concussion was almost two times greater in 18-year olds than in 13-year-old athletes. In comparable sports, girls had a 1.5 times higher concussion risk than boys. Athletes with a prior concussion had 3-5 times greater risk to sustain a concussion than those with no history of a concussion. Among varied sports, wrestling and martial arts had the highest relative risk of a concussion, followed by cheerleading, football, and track and field. No differences in concussion risks were found among the football players in different positions. Conclusions Older youths, females, those with a history of concussion, and those participating in high contact sports were found to have higher risks of sustaining a concussion. The findings increase awareness of concussion patterns in young athletes and raise concerns regarding protective strategies and concussion management in youth sports.

Objective The aim of this research was to examine the role of native language in the performance of youth athletes on a computerized neuropsychological test battery, the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Method The study compared the baseline test scores of 5545 participants whose native language was English versus 195 whose native language was not English. The mean age of the participants was 15.06 years. Results A multivariate analysis of variance revealed no differences in the five ImPACT Composite scores of the two language groups. Conclusion Contrary to prior research, one cannot simply expect that non-native English speakers will do more poorly on ImPACT than native English speakers. Further research on the use of ImPACT with other non-native English-speaking youth athletes is recommended.

The aim of this study was to examine the effects of head impact frequency on the neuropsychological test results of football players who participate in different positions on the team. Based on the biomechanical measures of head impact frequency reported in high school football, a High Contact group (n = 480) consisting of offensive and defensive linemen was compared with a Low Contact group (n = 640) comprised of receivers and defensive backs. The results revealed that the High Contact group obtained poorer performances on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) on three Composite scores (Verbal Memory, Visual Motor Speed, Impulse Control) and the Total Symptom score compared to the Low Contact group. The present study is the first, to date, to report differences in the neuropsychological test performances of athletes who participate in high and low contact football positions. The findings raise tentative concerns that youth football players exposed to repetitive head trauma, including subconcussive impacts, may be at risk for lowered neuropsychological functioning and increased symptoms.

This research evaluated the 2-year test-retest reliability of the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) neuropsychological battery, and clarified the need for biennial updated baseline testing of high school athletes. This study compared the baseline test scores of 212 non-concussed athletes that were obtained in Grade 9 and again 2 years later when they were in Grade 11. Regression-based methods indicated that 4 of the 5 ImPACT scores were stable over 2 years, as they fell within the 80% and 95% confidence intervals (CIs). The results suggested that updating baseline testing for high school athletes after 2 years is not necessary. Further research into the consistency of computerized neuropsychological tests over 2 years with high school athletes is recommended.

Establishing normative data of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance of high school athletes in Hawai'i.Pre-season ImPACT testing was performed on 751 participants in football, baseball, basketball, soccer, volleyball, softball, and track from 4 Oahu public high schools. The ImPACT composite scores included measures of Verbal Memory, Visual Memory Processing Speed, and Reaction Time. The descriptive statistical data collected were the group means, standard deviations, standard errors of measurement, distribution of scores and percentile ranks of (1) 262 boys ages 13 to 15; (2) 297 boys ages 16 to 18; and (3) 192 girls ages 13 to 18.The means and standard deviations of the 4 ImPACT composite scores for the 751 student-athletes in Hawai'i were similar to the ImPACT scores obtained from a master database of ImPACT test results. Although differences between the Hawai'i and mainland data were nonsignificant, there appeared to be a trend revealing somewhat lower scores in the Hawai'i sample of athletes.The similarity in ImPACT test performance of Hawai'i high school athletes as compared to the mainland normative data provides support for the applicability of this computerized neuropsychological battery in Hawai'i. However in view of a trend reflecting slightly lower ImPACT scores among Hawai'i participants, the use of the normative data produced by this study may be desirable in assessing Hawai'i high school athletes.