Concussion In Sport Group Research Articles

The Unconsidered Pathway: Suggestions for Physical Therapists to Facilitate Student Reintegration to Physical Education after a Concussion.

Background/Objectives: "Return-to-play" and "return-to-learn" after a concussion are familiar concepts due to guidelines proposed by the Concussion in Sport Group and Heads-Up Initiative. The purpose of this commentary is to expand upon the current consensus guidelines for treatment of concussed children and adolescents, as well as provide guidelines for returning to physical education (RT-PE) classes. Proposal: The authors propose one general and four subtype-specific guidelines post-concussion injury. This framework highlights the role of physical therapists in the management of children with prolonged recovery. The final RT-PE determination should occur with documented medical clearance from a licensed healthcare provider trained in the evaluation and management of a concussion. Conclusions: Despite significant gains regarding the management of concussed children and adolescents, confusion remains regarding RT-PE post-concussion. To eliminate ambiguity and promote adherence to a gradual return to activity protocols, the authors developed guidelines based on current evidence and recommendations.

Autonomy, relationality, and brain-injured athletes: a critical examination of the Concussion in Sport Group’s Consensus Statements between 2001 and 2023

ABSTRACT This article critically examines the development and consensus outputs of the Concussion in Sport Group. We examine the six Consensus Statements between 2001 and 2023 to explore the challenges that the presence of contextual forces pose to the development of effective and ethically justifiable medical guidelines to manage situations involving brain-injured athletes. First, we discuss the implicit and explicit ethical framework and goals underlining the statements. Secondly, drawing on a relational account of athlete choice, we expound on the limitations of the framework, concentrating on those resulting from a simplified understanding of athlete autonomy. Thirdly, we conclude by proposing a series of recommendations to improve concussion management protocols: (1) adopting a broader understanding of autonomy built upon relational accounts, beyond just the healthcare professional-athlete relationship; (2) further minimizing conflicts of interest that increase athletes’ vulnerability and hinder decision-making ability; (3) enhancing healthcare professional training to allow better adjustment of treatment plans to athletes’ contexts; and (4) promoting research on sociocultural elements affecting athletes’ vulnerability and autonomy.

Informing evidence-based policy for sport-related concussion: are the consensus statements of the concussion in sport group fit for this purpose?

ABSTRACT This essay explores how evidence-based policy can be developed for sport-related concussion (SRC), focusing particularly on the role and influence of the Consensus Statements of the Concussion in Sport Group (CiSG). Three credible policy purposes are suggested: (i) to mitigate acute health impacts of concussion events in sport; (ii) to reduce or eliminate the identified causes of SRC (direct blows to the head, neck, or body); and (iii) to improve long-term brain health outcomes for athletes. Eight of ten systematic reviews commissioned for the most recent Consensus Statement, and ten of its thirteen headings, address the first purpose. The primary influence of the CiSG Consensus Statements has been to improve SRC acute response practice and protocols in professional/elite sport, which has always been their primary policy purpose, although evidence of improvement is more limited in child/adolescent and recreational sport. But a primary focus on mitigating acute health impacts has crowded out other credible policy purposes of concern to stakeholder groups with whom evidence-based policy for SRC must be co-produced. No recommendations are made to improve long-term brain outcomes for athletes because concerns about imperfections in evidence are cited to question the link between such outcomes and SRC. Modifications to reduce or eliminate purposive blows to the head, neck, or body that are permitted as a structural part of the way some sports are played are given very limited attention, even when discussing prevention, where they are just one approach considered alongside protective equipment, neuromuscular strengthening, and concussion management strategies. The essay concludes that the CiSG should shift the primary policy purpose of its Consensus Statements to address the identified causes of SRC: purposive blows to the head, neck, or body. Reducing or removing causes of SRC both better safeguards children/adolescents and renders debates about the link between SRC and long-term brain health outcomes superfluous.

An Assessment of Existing Sport-Related Concussion Guidelines in Ireland: The Need for a United Approach.

In 2014, an Irish parliament white paper called for greater addressing of sport-related concussions (SRCs) in Ireland, requesting the adoption of the Concussion in Sport Group's (CISGs) guidelines and greater consistency in SRC return to play (RTP) management. Ten years later, it is unclear how these requests have been addressed. Recently, the United Kingdom's government centralised guidelines to one SRC document for all grassroots sports. This study aimed to investigate all publicly available SRC guidance in Irish sports and national governing bodies (NGBs) to determine if centralised guidelines are warranted. Sport Ireland and the Irish Federation of Sports were searched for all recognised NGBs and sports in Ireland. Websites were searched for any information pertaining to SRCs and data were extracted and collated in Microsoft Excel. In total, 15 of 83 sports and/or NGBs included SRC guidance, nine of which provided RTP protocols. Various iterations of the CISGs guidance and tools were implemented. Several sports with a documented SRC risk had no guidelines present. The findings indicate disjointed and outdated guidance across Irish sport. Additionally, there are sports with a documented concussion risk that have no SRC guidance available. This study provides support for centralised guidelines to be adopted in Irish grassroots sports.

Addressing conflicts of interest in the Consensus Statement on Concussion in Sport: a proposal to increase transparency by requiring authors to provide a reflexive explanation, not simply a declaration, of their competing interests

ABSTRACT The 6th Consensus Statement on Concussion in Sport is authored by the Concussion in Sport Group (CiSG) and intends to provide evidence-based recommendations on concussion management for the welfare of sports participants. However, the authors of the Consensus Statement have declared many competing links to third-party groups. While the declaration of an author’s competing interests is now a widely accepted practice within academic publishing aimed at greater transparency and research integrity, it is not a measure to remove the potential influence of third-party links. In the case of the Consensus Statement, this leaves uncertainty about how the potential sources of third-party bias declared by individual members of the CiSG may have influenced the CiSG’s interpretation of the existing state of evidence on concussion management and impacted the content of the recommendations contained with the Consensus Statement. Openly declaring third-party links falls short of securing trustworthiness in the Consensus Statement recommendations since it leaves end-users of the Consensus Statement with the task of interpreting the impact(s) of these competing interests with little information to guide them. This is because the authors themselves offer neither explanation nor guidance concerning potential bias arising from the competing interests that they have declared, which impinges upon the ability of readers to evaluate the trustworthiness of the content. The status quo could be improved by excluding researchers who have conflicts of interest. Nevertheless, if authors with competing interests are permitted to be part of the CiSG (as is the status quo), then I propose a novel option for increasing transparency that would require authors of the Consensus Statements to provide a reflexive explanation, not simply a declaration, of their competing interests.

Head injuries: What the team physician needs to know

Aconcussion is the mildest form of amild traumatic brain injury (tbi) and resembles the most prevalent type of sports associated tbi. Diffuse axonal injuries, the main pathophysiological mechanism of concussion, leads to disruption of communication between different brain areas. The resulting clinical symptoms may relate to several clinical domains (cognition, fatigue, anxiety disorders, headaches/migraines or vestibulo-ocular problems), all of which need to be assessed in aclinical screening during an evaluation for possible concussion. Appropriate and consensus-based protocols to conduct clinical exams are provided by the Concussion in Sport Group (Sport Concussion Assessment Tool (SCAT), Sport Concussion Office Assessment Tool (SCOAT)) and should be used in the most up-to-date version. Therapeutically, slowly and incrementally increasing sub symptomatic activation consisting of daily routine activities, aerobic and cognitive exercises should be introduced early after the trauma. Education about concussion should be geared towards target audiences and will then greatly contribute to adherence and acceptance of medical management.

‘The highest confidence that repetitive head collisions causes chronic traumatic encephalopathy’? Analysing the scientific knowledge in the Rugby Union concussion litigation of England and Wales

295 rugby players have begun legal proceedings against World Rugby, the Rugby Football Union and the Welsh Rugby Union. The claimants report they are suffering from chronic traumatic encephalopathy. Among the allegations against the defendants is that the player safety regulations (i.e. the Pitch Side Concussion Assessment and Return to Play protocols) in place at the time of injury were done without proper medical foresight and increased the risks of concussion to players. World Rugby’s safety regulations are informed by the work of the Concussion in Sport Group which maintains that the link between collisions and concussion is unclear. However, recent studies report an unprecedented confidence that sports-related concussion causes brain disease. In 2022, the Concussion in Sport Groups lead author resigned due to 10 counts of plagiarism. This saga risks damaging public respect for both the safety regulations and the science underpinning it. This article examines the state of the scientific literature and considers the challenges in proving (1) the governing bodies breached their duty of care and; (2) the causal link between collisions and brain injury. This article argues that 2022 marked the year that defendants can no longer deny the dangers of sports-related concussion, however, defining the moment when the risks ought to be known remains onerous. On causation, this article examines the principles of material contribution, doubling of the risk, and the material increase in risk. The article concludes with policy considerations inviting an extension of the material increase in risk principle to sports settings.

The Past, Present, and Future of Sport-Related Concussions

Sport-related concussions significantly affect Canadian athletes, with 85% of varsity football players sustaining more than one concussion throughout their career. When a concussion is suspected, the athlete is removed from play, assessed using a concussion assessment tool, and prescribed a stepwise return-to-play protocol. At the International Conference on Concussion in Sport, hosted in 2001, 2004, 2008, and 2016, the Concussion in Sport Group revised and updated concussion assessment tools from the SCAT to the SCAT-5 and evolved return-to-play guideline theory from complete rest to light aerobic exercise. Future advancements aim to track athletes' blood biomarkers to determine if they have completely recovered from the post-concussive neurometabolic cascade and can safely recommence sport.

Prospective Study of Gray Matter Atrophy Following Pediatric Mild Traumatic Brain Injury.

The clinical and physiologic time course for recovery following pediatric mild traumatic brain injury (pmTBI) remains actively debated. The primary objective of the current study was to prospectively examine structural brain changes (cortical thickness and subcortical volumes) and age-at-injury effects. A priori study hypotheses predicted reduced cortical thickness and hippocampal volumes up to 4 months postinjury, which would be inversely associated with age at injury. Prospective cohort study design with consecutive recruitment. Study inclusion adapted from American Congress of Rehabilitation Medicine (upper threshold) and Zurich Concussion in Sport Group (minimal threshold) and diagnosed by Emergency Department and Urgent Care clinicians. Major neurologic, psychiatric, or developmental disorders were exclusionary. Clinical (Common Data Element) and structural (3 T MRI) evaluations within 11 days (subacute visit [SA]) and at 4 months (early chronic visit [EC]) postinjury. Age- and sex-matched healthy controls (HC) to control for repeat testing/neurodevelopment. Clinical outcomes based on self-report and cognitive testing. Structural images quantified with FreeSurfer (version 7.1.1). A total of 208 patients with pmTBI (age = 14.4 ± 2.9; 40.4% female) and 176 HC (age = 14.2 ± 2.9; 42.0% female) were included in the final analyses (>80% retention). Reduced cortical thickness (right rostral middle frontal gyrus; d = -0.49) and hippocampal volumes (d = -0.24) observed for pmTBI, but not associated with age at injury. Hippocampal volume recovery was mediated by loss of consciousness/posttraumatic amnesia. Significantly greater postconcussive symptoms and cognitive deficits were observed at SA and EC visits, but were not associated with the structural abnormalities. Structural abnormalities slightly improved balanced classification accuracy above and beyond clinical gold standards (∆+3.9%), with a greater increase in specificity (∆+7.5%) relative to sensitivity (∆+0.3%). Current findings indicate that structural brain abnormalities may persist up to 4 months post-pmTBI and are partially mediated by initial markers of injury severity. These results contribute to a growing body of evidence suggesting prolonged physiologic recovery post-pmTBI. In contrast, there was no evidence for age-at-injury effects or physiologic correlates of persistent symptoms in our sample.

Factors Influencing Coaches’ Decisions about Concussion on the Sidelines of Youth Sports

ObjectiveIdentify coach reported factors influencing decisions about potential concussion in youth sports.BackgroundYouth concussion in sport is an established public health concern. Coaches are the primary stakeholders deciding about removal from play for suspected concussion on the sidelines of competition and practice in most youth sports organizations. Estimates indicate over 2 million adults coach youth sports. Legislation across the U.S. and guidance from the Centers for Disease Control and the Concussion in Sport Group recommend players with suspected concussion be removed from play and not return prior to medical clearance and a graduated return to play protocol be followed.Design/MethodsQualitative semi-structured 1:1 interviews with coaches of youth community or school sponsored athletic programs in Illinois. Interview data was analyzed according to a constructivist grounded theory methodology employing constant comparative methods with an inductive approach to theme emergence.ResultsSixteen coaches of recreational, competitive and scholastic athletic teams participated. Coaches were primarily white (94%) males (81%) with an average age of 47. Ten were volunteer coaches. Analytic themes related to decision making include: 1) personal experience drives decisions more than concussion training, 2) coaches fear the legal liability of missing a concussive event on the field, and 3) discomfort with the ambiguity of making decisions on the field. Coach perceived factors for improving comfort with decision making were: 1) availability of checklists or tools for use on the sidelines, 2) improve shared decision making with all stakeholders, and 3) access to medical professionals on the sidelines.ConclusionsThere is a possible misalignment between coaches’ actual practices on the field and best practice guidelines. Coaches report behaviors on the sidelines that are distinct from practice guidelines and public health initiatives related to removal from play and return to play when events on the field present the potential for concussion.

Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York

There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and...

Updates in Concussion Consensus Statement Offer Symptom-Limited Physical Activity

This article discusses the Concussion in Sport Group's (CISG) new consensus statement from 2017 pertaining to symptom-limited physical activity and issues relating to return to play (RTP) and return to school (RTS) for coaches and physical education teachers.

Zurich to Berlin-"Where" Are We Now with the Concussion in Sport Group?

The Concussion in Sport Group recently published its highly anticipated fifth consensus statement on sports-related concussion. The latest iteration features a new organizational format-the "11 Rs" and has input from a wider range of health care professionals, organizations, and experts in the field from both the sport concussion area and from related areas outside of sport. The stated objective of this current document is to "build on the principles outlined in previous statements and develop further conceptual understanding of sports-related concussion." Its intended audience is "physicians and health care providers who are involved in athlete care, whether at a recreational, elite, or professional level." We review significant updates including recommendations for sideline evaluation, return to play, and return to learn in athletes with sports-related concussion.

Sport-related concussive convulsions: a systematic review

ABSTRACTObjectives: The incidence of sport-related concussion (SRC) continues to rise. Presentations of concussed athletes vary from subtle symptoms to notable signs. Between the 4th and 5th iterations of the Concussion in Sport Group (CISG) guidelines, concussive convulsions were removed as a modifying factor, but little evidence or discussion supported this change. While considerable research exists regarding post-traumatic epilepsy in moderate to severe traumatic brain injury, convulsions following SRC are relatively understudied. There is no clear consensus on the prevalence of convulsions, seizures, or the management of these entities following SRC. The aim of this review was to assess the state of the literature, describe the management trends of concussive convulsions and post-traumatic epilepsy in the SRC population, and provide evidence and guidance for the management of these athletes.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adapted for a review of heterogeneous literature. English-language titles and abstracts published prior to June 2017 were searched systematically across four electronic databases. Primary peer-reviewed journal articles were included if they reported individuals of any age or gender who suffered a concussion or mild traumatic brain injury that was associated with seizure activity during a sports/recreational event.Results: Of 852 records screened for review, 58 full-text articles were assessed for eligibility. Eight studies with 130 athletes total met the inclusion criteria. Of these individuals suffering a SRC convulsion or a post-concussive seizure, 0.8% received antiepileptic medications, 24.6% underwent electroencephalography, and 30.8% underwent brain imaging. The mean time until the participant returned to play was 14.8 days. Only 6.9% developed long-term sequelae over a mean follow-up time of 3.3 years.Conclusions: The current literature describing concussive convulsions and post-concussion seizure in sports is limited. A void of primary literature concerning the management of patients with concussive convulsions or seizures and the long-term sequelae among this population remains. However, the evidence available suggests that concussive convulsions do not need to be a primary modifying factor in the management of SRC.

Ability of scat3 and childscat3 to discriminate children with concussion from children with upper limb injuries and uninjured children in the emergency department

ObjectiveTo evaluate the ability of SCAT3 and ChildSCAT3 to discriminate children with concussion from children with upper limb injuries and uninjured children in the emergency departmentDesignProspective observational study.SettingTertiary children’s hospital emergency department.Participants264 children presenting to ED with concussion (CONC, n=90) and two control groups (i) upper limb injury (ULI, n=90) and (ii) well children (WELL, n=84) with equal sized subgroups in three age bands of 5–8, 9–12, and 13–16 years.Assessment and outcomeChild-SCAT3 was used in 5-12 years, SCAT3 in 13–16 years, administered by trained research assistants. Differences between study groups were analysed using ANOVA. Effect sizes were also assessed.ResultsThe number and severity of child and parent reported symptom scores for SCAT3 and the child-SCAT3 were significantly higher in CONC than either control group (p<0.001). Mean double and tandem stance errors were also significantly higher (p<0.001), and immediate memory and concentration were significantly lower for the CONC group (p<0.01). No group differences were found for orientation and digit backwards.Among SCAT3 symptoms, headache and pressure in head had the highest effect size (0.51 and 0.44 respectively, p<0.001). Among Child SCAT3 symptoms, I have headaches and I feel dizzy had the highest effect size (0.31 and 0.23 respectively, p<0.001). There were no significant differences between ULI and WELL control groups.ConclusionsOverall, SCAT3 and child-SCAT3 can differentiate concussed from non-concussed patients, in particular for number and symptom severity. However, some neuropsychological subtests do not differentiate concussed patients and controls.Competing interestsGAD is an honorary member of the Australian Football League Concussion Working Group, and has attended meetings organised by sporting organisations including the National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. GAD is a member of the International Concussion in Sport group that developed the SCAT3 and ChildSCAT3

Ability of children aged 5-16 years to perform scat3 and child-scat3 testing in the emergency department

ObjectiveTo evaluate children’s ability to perform the child-SCAT3 and SCAT3 Sports Concussion Assessment Tool.DesignProspective observational study.SettingTertiary children’s hospital emergency department.Participants264 children presenting to ED with concussion (CONC, n=90) and two control groups (i) upper limb injury (ULI, n=90) and (ii) well children (WELL, n=84) with equal sized subgroups in three age bands of 5–8, 9–12, and 13–16 years.Assessment and outcomeAbility to complete SCAT subtests administered by trained research assistants, stratified by age band and participant group. Child-SCAT3 was used for 5–12 years, SCAT3 for 13–16 years.ResultsInability to complete at least one sub-test of child-SCAT3 occurred in 29 (32.2%) of the 5-8 year age band and 5 (5.5%) in the 9–12 year age band. The 5 and 6 year olds had the lowest completion rates. In the 13–16 year age band 11 (13.3%) participants were unable to complete at least one sub-test of SCAT3.The most frequent reasons for inability to complete any sub-test (n=116) were ‘did not understand’ (n=45), and ‘refusal to continue’ (n=26). Fewer were due to ‘feeling too unwell to continue’ (n=13).The subtests with the highest rates of inability to complete were child-SCAT3 and SCAT symptoms scale (n=17), BESS (n=9), coordination (n=9), digits backwards (n=8) and concentration (n=8).ConclusionsChild-SCAT3 should be applied with caution in young children due to an inability to understand certain test items and may need to be modified. SCAT3 can be reliably applied in teenagers 13–16 years of age.Competing interestsGAD is an honorary member of the Australian Football League Concussion Working Group, and has attended meetings organised by sporting organisations including the National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. GAD is a member of the International Concussion in Sport group that developed the SCAT3 and ChildSCAT3.

The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale

The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool 2 that was initially introduced by the Concussion in Sport Group in...

Comparison of baseline and post-concussion ImPACT test scores in young athletes with stimulant-treated and untreated ADHD

ABSTRACTObjectives: Baseline and post-concussion neurocognitive testing is useful in managing concussed athletes. Attention deficit hyperactivity disorder (ADHD) and stimulant medications are recognized as potential modifiers of performance on neurocognitive testing by the Concussion in Sport Group. Our goal was to assess whether individuals with ADHD perform differently on post-concussion testing and if this difference is related to the use of stimulants.Methods: Retrospective case-control study in which 4373 athletes underwent baseline and post-concussion testing using the ImPACT battery. 277 athletes self-reported a history of ADHD, of which, 206 reported no stimulant treatment and 69 reported stimulant treatment. Each group was matched with participants reporting no history of ADHD or stimulant use on several biopsychosocial characteristics. Non-parametric tests were used to assess ImPACT composite score differences between groups.Results: Participants with ADHD had worse verbal memory, visual memory, visual motor speed, and reaction time scores than matched controls at baseline and post-concussion, all with p ≤ .001 and |r|≥ 0.100. Athletes without stimulant treatment had lower verbal memory, visual memory, visual motor speed, and reaction time scores than controls at baseline (p ≤ 0.01, |r|≥ 0.100 [except verbal memory, r = −0.088]) and post-concussion (p = 0.000, |r|> 0.100). Athletes with stimulant treatment had lower verbal memory (Baseline: p = 0.047, r = −0.108; Post-concussion: p = 0.023, r = −0.124) and visual memory scores (Baseline: p = 0.013, r = −0.134; Post-concussion: p = 0.003, r = −0.162) but equivalent visual motor speed and reaction time scores versus controls at baseline and post-concussion.Conclusions: ADHD-specific baseline and post-concussion neuropsychological profiles, as well as stimulant medication status, may need to be considered when interpreting ImPACT test results. Further investigation into the effects of ADHD and stimulant use on recovery from sport-related concussion (SRC) is warranted.

The Sport Concussion Assessment Tool: a systematic review

OBJECTIVE Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date. METHODS English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non-SCAT-related assessment were excluded. RESULTS The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on baseline differences associated with age, sex, concussion history, and the ability to detect an SRC. CONCLUSIONS Looking toward the upcoming Concussion in Sport Group meeting in fall 2016, one may expect further revision to the SCAT3. However, based on this systematic review, the authors propose further, in-depth study of an already comprehensive concussion test, with acute, diagnostic, as well as long-term use.

Are psychotropic medications associated with differences in baseline neurocognitive assessment scores for young athletes? A pilot study

Objectives. Baseline and post-concussive neurocognitive testing is useful in managing concussed athletes. The Concussion in Sport Group has postulated that the use of psychotropic medications is a modifying factor in the management of sport-related concussion. About 7% of US adolescents are prescribed psychotropics in a given year. Our aim was to investigate whether psychotropic medication use or psychiatric illness is associated with differences in baseline neurocognitive test scores. Methods. From 2007 to 2012, over 7000 athletes underwent pre-participation baseline neurocognitive testing using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. Following application of inclusion and exclusion criteria, athletes’ self-reported medication lists were reviewed and: 1) classified as psychotropic or not and 2) subclassified. Group subclassification yielded: 1) use of any psychotropic medication, 2) psychostimulant use, 3) antidepressant use and 4) self-reported history of depression and/or anxiety without psychotropic use. Each group was matched, by sex, age, body mass index, education level and concussion history with athletes who were not reportedly prescribed psychotropic medications or did not report a depression/anxiety history, respectively. Each group’s baseline ImPACT scores were compared to matched controls. Results. The use of prescribed psychotropic medications without regard to subclass had no effect on baseline ImPACT composite scores among athletes ages 13–25. However, athletes reportedly prescribed psychostimulants displayed significantly lower visual motor speed scores (32.8 vs 37.1, p = 0.030) and slower reaction times (0.65 vs 0.60, p = 0.044) than non-users. In contrast, antidepressant users displayed significantly faster reaction times (0.58 vs 0.61, p = 0.029). Those reporting a history of depression/anxiety, not treated with psychotropics, displayed significantly lower visual memory (70.4 vs 75.2, p = 0.010) and higher symptom scores (8.83 vs 4.72, p = 0.005). Conclusions. This pilot study suggests that self-reported psychotropic medications are associated with differences in baseline ImPACT test scores, which appear dependent on medication subclass. Our preliminary results support the inclusion of psychotropic medications, specifically psychostimulants and antidepressants, as well as history of depression/anxiety as potential concussion modifiers.