Disparities in baseline neurocognitive testing for student concussion management in Massachusetts high schools

Abstract

PurposeThere is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to assess whether the scope of testing is associated with the economic status of student populations in MA.MethodsA cross-sectional secondary analysis of surveys conducted with MA athletic directors (n=270) was employed to investigate school characteristics associated with the provision of BNT. Correlation and regression analyses were used to assess whether the scope of testing is associated with the economic status of student populations in MA.ResultsThe scope of BNT was independently associated with the economic disadvantage rate (EDR) of the student population (β=−0.02, p=0.01); whether or not the school employs an athletic trainer (AT) (β=0.43, p=0.03); and school size (β=−0.54, p=0.03). In a multivariable regression model, EDR was significantly associated with the scope of baseline testing, while controlling for AT and size (β=−0.01, p=0.03, adj-R2=0.1135).ConclusionAmong public high schools in MA, disparities in the provision of BNT for students are associated with the economic characteristics of the student body. Schools that have a greater proportion of low-income students are less likely to provide comprehensive BNT. The clinical implications of not receiving BNT prior to concussion may include diminished quality of postconcussive care, which can have short-term and long-term social, health-related and educational impacts.

Health Care Navigation of Black and White Adolescents After Sport-Related Concussion: A Path Toward Health Equity

“…Racial disparities have been documented along the spectrum of clinical care; however, representation of Black people or other minoritized groups is often missing in published SRC studies making this difficult to discern. Although previous research demonstrates disparities in access to ATs, 10 accessible baseline neurocognitive testing, 26 use of subspecialty concussion care, 19 and concussion symptom knowledge, 9 understanding care paths between groups can help to answer questions regarding recovery timelines and treatment pathways. Research by Bretzin and colleagues 27 showed that the median time to medical clearance after a SRC varied by healthcare provider and medical facility.…”

Concussion laws decrease litigation and brain injuries

“…One of the states that included the baseline neurocognitive test in the concussion law is Massachusetts (Doucette et al, 2016) [7] . According to Campbell et al, (2020) [3] , Massachusetts requires all schools to be resourceful enough to purchase a baseline neurocognitive testing program. Also, the qualified personnel who administer the test must have administration experience.…”

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

“…Among high school athletes, Black athletes have also been reported to be less knowledgeable about concussion signs and symptoms than White athletes, 16 which may prevent them from seeking assessment and care. Improving access to education and health care resources for all populations may lead to more equitable care and outcomes in concussion management 16,17 …”

“…Improving access to education and health care resources for all populations may lead to more equitable care and outcomes in concussion management. 16,17 Outcomes of concussion vary and range from full, rapid recovery to chronic neurologic dysfunction and other sequelae. 7 In children and adolescents, sportsrelated concussions have repeatedly demonstrated significant impacts on academic performance.…”