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

Despite horse racing's exceptionally high concussion risk, there is no jockey-specific ImPACT study. This work aimed to develop demographically adjusted, jockey-specific ImPACT norms and to evaluate complementary approaches to clinical classification.

Retrospective baseline data from 663 Irish jockeys (2021-2024) were analyzed. Two normative methods were applied: (i) a univariate regression-based approach estimating expected scores for each cognitive domain independently, adjusting for age, sex, and education, with percentile-based classification; and (ii) a multivariate regression-based tolerance region method jointly modeling cognitive outcomes to estimate a (95%/95%) tolerance region. Concordance and discordance between methods were examined, and demographic effects on derived cutoffs were quantified.

Both methods demonstrated complementary diagnostic value. Multivariate tolerance regions reduced overinterpretation of isolated low scores, whereas univariate regression was more responsive to domain-specific deviations. Performance profile in Irish jockeys was lower than that reported in other athletic populations, with protective effects of education, age-related decline, and superior performance observed among female jockeys.

Combined use of univariate and multivariate normative approaches provides a more robust framework for interpreting ImPACT performance. An interactive web-based application was developed to support clinical and research use. Although applied here to horse racing, this framework is readily transferable to other sports.