The Effect of School Socioeconomic Status and Sport on Adolescent Athletes’ Baseline Concussion Assessment

Abstract

PURPOSE:The purpose is to examine the effect of school socioeconomic status (SES) and sport on the baseline performance of adolescent athletes on the King-Devick test (KD), modified Balance Error Scoring System (mBESS), and Post Concussive Symptom Inventory (PCSI). METHODS:A retrospective cohort study was conducted on athletes’ baseline concussion assessments completed as part of a concussion surveillance program. Testing included a history and risk factor questionnaire, KD, mBESS, and PCSI. Schools and sports clubs were classified as high SES (private or <50% free/reduced lunches) vs. low SES (public, > 75% free/reduced lunches). Sports were categorized as collision, contact, and non-contact. An ANCOVA was performed for each outcome while controlling for age RESULTS:Analysis was conducted on 377 athletes (63% M), average age 15.9+1.5 years (range 12.1-19.2). Two schools and 1 club were classified as high SES (n=162); 5 schools (n=215) were classified as low SES. For KD score, only a significant school × sport interaction was observed (p=0.01), with age as a significant co-variate (p=0.01). Only a significant main effect of school was observed for the mBESS (p=0.02), while a significant main effect of school (p=0.001) and school × sport interaction (p=0.02) was observed for PCSI. Age was not significant for either mBESS or PCSI (p>0.47). CONCLUSIONS: This study examines the influence of school SES and sport on baseline KD, mBESS, and PCSI. KD scores were slower in contact and non-contact athletes of high SES schools compared to low SES school athletes. Additionly, low SES school contact and non-contact athletes reported higher baseline PCSI scores compared to their high SES school counterparts. These findings have implications for how baseline scores are considered as comparisons for concussion surveillance; however, more studies are necessary to examine other confounding factors and the utility of these measures in managing injury recovery.