Abstract:
Context: Baseline neurocognitive testing has been recommended to provide more accurate representation of the pre-concussion cognitive status of individual athletes.1 Socioeconomic status is an aspect that is not controlled for when obtaining baseline scores, which may lead to inaccurate findings if comparing scores to normative data. Understanding the role of socioeconomic status in baseline testing is important for the accurate analysis of test scores and proper evaluation of patients. Minimal data has investigated socioeconomic status on baseline testing scores in secondary school athletes. Objective: To investigate the effects of free or reduced lunch on baseline concussion scores in secondary school athletes. Design: Cross sectional. Setting: Computer lab of 2 public secondary schools. Patients or Other Participants: 1,788 secondary school athletes (age = 14.96 ± 1.11 years, height = 171.25 ± 17.83 cm, mass = 66.82 ± 21.63 kg). Interventions: Free or reduced lunch eligibility served as the independent variable. Main Outcome Measures: Participants took Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) within the past 5 years. Components of ImPACT included word discrimination, design memory, X’s and O’s, symbol match, color match, and three letter memory. Each of these components are combined into 5 composites. Results: Of the 1,788 participants in this study, 1,255 were not eligible for free or reduced lunch, whereas 563 were eligible. Free or reduced lunch eligibility significantly altered the combined dependent variables (multivariate F4,1783 = 18.60, P < .001, ɳ2 = .04). Follow up ANOVAs showed that free or reduced lunch eligibility altered verbal memory (P =< .001), visual memory (P =< .001), visual motor (P =< .001), and reaction time (P =< .001). Those who were eligible for free or reduced lunch had lower verbal memory scores (81.33 ± 12.72) compared to those who were not eligible (84.68 ± 11.88). Those who were eligible for free or reduced lunch had lower visual memory scores (71.29 ± 13.83) in comparison to those who were not (74.94 ± 14.34). Qualified student-athletes for free or reduced lunch had lower visual motor scores (34.68 ± 7.88) compared to those who were not qualified (37.60 ± 7.45). Participants eligible for free or reduced lunch had higher reaction times (.65 ± .12) in comparison to those who were not eligible (.61 ± .11). Conclusion: Our results indicate socioeconomic status, when measured by free or reduced lunch eligibility, significantly altered visual, verbal, and reaction time components of baseline neurocognitive testing. If normative data is used instead of independent baselines, potential modifiers such as socioeconomic status should be taken into account when analyzing concussion scores to provide accurate diagnoses. Keywords: ImPACT, concussion, baseline modifier.