Exploring Racial Disparities in Performance on Baseline Concussion Measures

Journal of Athletic Training -


Wallace, J. S., Moran, R. N., Steen, J., Palumbo, M. and Leghart, S..



Context: Baseline concussion assessment often includes measures of neurocognitive and ocular abilities. A large amount of neurobiopsychosocial variance in baseline performance has yet to be explained and racial differences on baseline measures have been understudied. Understanding how racial differences may contribute to ocular and neurocognitive performance may aid in the interpretation of deviant scores and help clinicians to identify athletes at risk for poorer outcomes after injury. Objective: To determine if racial disparities exist between Black and White high school athletes on baseline neurocognitive and ocular concussion measures Design: experimental design Setting: Participants reported to their respective high schools to complete pre-season baseline concussion testing Patients or Other Participants: A total of 655 high school athletes (433 white, 222 black, 148 female, 507 male) from 10 high schools participated in this study. The mean age was 15.45 ± 1.21. Interventions: Athletes self-reported their race on the demographic section of their pre-participation examination. The Immediate Post Concussion Assessment and Cognitive Test (ImPACT) was administered in a group setting in a supervised, quiet room at each school by a licensed athletic trainer. In addition, the King-Devick test was completed individually with each athlete. The independent variable was race (black and white). Main Outcome Measures: To determine differences between black and white high school athletes on the KD time and ImPACT composite scores of verbal memory, visual memory, visual motor processing speed, reaction time and symptom score, a series of analysis of covariance (ANCOVA) statistical analyses were conducted, with sex as a covariate. Statistical analyses were conducted with the p-value set at .05. Results: The results of this study revealed significant differences between black and white high school athletes on baseline verbal memory (p < .001), visual memory (p < .001), reaction time (p < .001) and symptom score (p = .01). White athletes performed better than black athletes on verbal memory, visual memory, and reaction time. Black athletes reported higher baseline symptom scores than white athletes. There were no significant differences between black and white athletes on visual motor processing speed (p = .29) or KD time (p = .09). Conclusions: Black high school athletes demonstrated disparities on some baseline neurocognitive measures. While much of the concussion-related research has yet to study racial differences, neurobiopsychosocial factors associated with race may influence how an athlete performs on ocular and neurocognitive concussion measures. These results suggest capturing a baseline on each individual. Cognitively normal black athletes may be misdiagnosed when compared to white athletes, or normative values, in the absence of a baseline assessment.

Links to full article: