The Effects of Cognitive Maturity on Concussion Assessment in Low Socioeconomic Urban High School Athletes

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British Journal of Sports Medicine






Background: Implementing concussion assessment programs for youth athletes are necessary to manage clinical care in sports. However, confounding factors such as cognitive maturity and socioeconomic status may complicate clinical interpretation of testing following concussion.

Objective: Determine the stability of test scores between low socioeconomic athletes and non-athletes.

Design: Prospective longitudinal between-groups cohort design.

Setting: Youth Sports.

Participants: High school students (n=783) were recruited either prior to their competitive season or during the academic year to establish baseline cognitive function.

Interventions: All participants were administered annual baseline testing on computerized neuropsychological test battery (ImPACT) to track the effect of cognitive maturity. Using SPSS, a one-way ANOVA with repeated measures (group×time) was run on ImPACT composite scores, using an alpha level of .05 for all tests.

Main Outcome Measurements: ImPACT composite scores.

Results: Significant interactions of group and time existed for composite visual motor (Wilks' λ=0.97, F(1,782)=20.53, p<.001, η2=.03) and composite reaction time (Wilks' λ=0.99, F(1,782)=5.65, p<0.05, η2=0.01.) between athletes and non-athletes. Significant main effects for time were seen in composite impulse control (Wilks' λ=0.99, F(1, 782)=4.05, p<0.05, η2=0.01.) with lower scores during year one. Significant differences existed between 10th and 12th grade participants compared to 9th grade participants on composite visual motor (p=0.006), and total symptoms (p=0.043) with older participants performing better.

Conclusions: Cognitive maturity does not appear to affect composite ImPACT scores, however there is a break in composite visual motor scores between older and ninth grade participants. The need for annual baseline testing may not be warranted beyond tenth grade. Future research should examine test scores across a high school career to gain more understanding of changes related to cognitive maturity.