Improving concussion assessment in jockeys: normative benchmarks and web-based tool for ImPACT interpretation.

Overview

• This study developed and evaluated jockey-specific normative benchmarks for concussion assessment using the ImPACT tool, tailored to demographic factors, and introduced a web-based application to improve clinical interpretation of cognitive testing in jockeys.

Background and Motivation

• Horse racing involves a very high risk of concussion due to frequent falls and impacts experienced by jockeys.
• Despite this high risk, previous research had not established normative concussion assessment data specifically for jockeys using the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) tool.
• General concussion norms from other sports or populations may not accurately reflect jockey performance or concussion impact due to demographic and sport-specific factors.

Study Objectives

• Develop jockey-specific normative data for ImPACT cognitive test scores that adjust for important demographic variables such as age, sex, and education.
• Evaluate two different statistical approaches for clinical concussion classification based on these norms:
• A univariate regression-based method that analyzes each cognitive domain independently.
• A multivariate regression-based tolerance region method that jointly models all cognitive domains together.
• Compare the consistency and differences between these two norming methods in their classification results.
• Create a practical, web-based tool that clinicians and researchers can use for improved concussion assessment interpretation tailored for jockeys.

Methods

• Retrospective baseline cognitive assessment data from 663 Irish jockeys collected between 2021 and 2024 were analyzed.
• Two normative methods applied:
• Univariate regression method: Calculated expected scores for individual cognitive domains while adjusting for demographic variables (age, sex, education), then classified scores based on percentiles.
• Multivariate tolerance region method: Modeled all cognitive outcomes simultaneously to establish a 95% confidence tolerance region for normal cognitive performance.
• Evaluated agreement (concordance) and discrepancies (discordance) between the methods in classifying cognitive test results.
• Assessed how demographic factors influenced classification cutoffs and performance profiles.

Key Findings

• The two statistical methods showed complementary clinical value:
• The multivariate approach was more conservative, reducing false positives by avoiding overinterpretation of isolated low domain scores.
• The univariate method was better at detecting specific domain impairments, being more sensitive to localized deficits.
• Baseline cognitive performance of Irish jockeys was generally lower than norms reported for athletes in other sports, indicating the need for sport-specific benchmarks.
• Demographic effects observed:
• Higher education provided a protective effect, associated with better performance.
• Age-related cognitive decline was detectable, necessitating age adjustments.
• Female jockeys outperformed males on certain cognitive domains.

Clinical and Research Implications

• Using both methods in tandem offers a more robust framework for concussion assessment in jockeys by balancing sensitivity and specificity.
• The developed web-based application allows clinicians to input test scores and receive demographically adjusted, normative interpretations facilitating better concussion management decisions.
• Though this study focused on horse racing jockeys, the norming framework and tool can be adapted easily to other sports or populations requiring tailored concussion assessment.

Conclusion

• This research fills a critical gap by providing the first jockey-specific ImPACT concussion assessment norms adjusted for demographics.
• It demonstrates that combining univariate and multivariate normative models enhances interpretive accuracy.
• The interactive web tool supports evidence-based clinical decisions in concussion management for jockeys and can serve as a model for other sports contexts.