Modified Maddocks Questions Tool in Spanish: evaluating comprehension among child soccer players aged 4–8

Introduction: The Modified Maddocks Questions Tool (MMQT) is part of the Concussion Recognition Protocol used for sideline assessment of suspected concussion. Although widely used in English-speaking populations, it has not been validated in Spanish-speaking children. This study aimed to evaluate comprehension and response accuracy of a Spanish-adapted MMQT in soccer players aged 4-8 years. Methods: We conducted a cross-sectional observational study in Montevideo, Uruguay, between July and October 2024. Eighty-eight male soccer players aged 4-8 years were assessed at halftime using a Spanish-adapted version of the MMQT. Comprehension was evaluated by asking participants to reformulate each question. Associations between age, comprehension, and response accuracy were analyzed using chi-square or Fisher's exact tests and logistic regression models. Results: No statistically significant association was found between age and either comprehension or accuracy. Overall comprehension exceeded 96%. However, Question 4 ("Which team won the last match?") consistently showed a lower correct response rate across all ages. Our findings reinforce previous observations showing that questions assessing recall of past events can be challenging for younger children and suggest caution when evaluating MMQT responses in this age group. Conclusions: The Spanish-adapted MMQT demonstrates high comprehension and may be suitable for sideline concussion screening in children aged 5-8 years. However, Question 4 appears less reliable and should be reconsidered in future versions. A conservative approach is recommended, whereby any incorrect response warrants removal from play for further evaluation.