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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.