Group Differences in Postconcussion Cognitive, Physical, Sleep-Arousal, and Affective Symptom Subscales in High School and Collegiate Athletes by Race, Gender, and Competitive Level.

OBJECTIVE: Prior psychometric research has identified symptom subscales for the Post-Concussion Symptom Scale (PCSS) based on confirmatory factor analysis (CFA), including cognitive, physical, sleep-arousal, and affective symptom factors. Study objectives included: (1) replicate the 4-factor PCSS model in a diverse sample of athletes with concussion, (2) test the model for invariance across race, gender, and competitive level, and (3) compare symptom subscale and total symptom scores across concussed groups with established invariance. SETTING: Three regional concussion care centers. PARTICIPANTS: A total of 400 athletes who completed the PCSS within 21 days of concussion (64% boys/men, 35% Black, and 69.5% collegiate athletes). DESIGN: Cross-sectional. MAIN MEASURES: A CFA tested the 4-factor model and measurement invariance testing was performed across racial, competitive level, and gender groups. Symptom subscales and total symptom severity scores were compared based on demographic groupings with established invariance. RESULTS: The 4-factor model fit well and strong invariance was established across all demographic categories, indicating symptom subscales could be meaningfully compared across groups. Black and White athletes differed on total symptoms (U = 15 714.5, P = .021, r = 0.12), sleep-arousal symptoms (U = 15 953.5, P = .026, r = 0.11), and physical symptoms (U = 16 140, P = .051, r = 0.10), with Black athletes reporting slightly more symptoms. Collegiate athletes reported greater total symptom severity (U = 10 748.5, P < .001, r = 0.30), with greater symptom reporting on the cognitive (U = 12 985, P < .001, r = 0.21), sleep-arousal (U = 12 594, P < .001, r = 0.22), physical (U = 10 959, P < .001, r = 0.29), and emotional (U = 14 727.5, P = .005, r = 0.14) symptom subscales. There were no significant differences by gender in the total symptom score or subscale scores. After controlling for time since injury, no racial differences persisted, but a significant difference by competitive level in physical symptom reporting (F = 7.39, P = .00, η2 = 0.02) and total symptom reporting (F = 9.16, P = .003, η2 = 0.02) remained. CONCLUSION: These results provide external validation for the PCSS 4-factor model and demonstrate that symptom subscale measurements are comparable across race, genders, and competitive levels. These findings support the continued use of the PCSS and 4-factor model for assessing a diverse population of concussed athletes.

Systematic Review Examining the Reporting of Race and Ethnicity in Sport-Related Concussion Studies.

OBJECTIVE: Sport-related concussion (SRC) is an evolving public health concern among youth athletes. Despite emerging evidence that race/ethnicity are important factors in determining concussion outcomes, studies examining race/ethnicity are limited. We conducted a systematic review to: 1) determine the prevalence of SRC studies that report race/ethnicity of their participants, 2) describe how race/ethnicity are used within each study, and 3) assess predictive factors for reporting of race/ethnicity. DATA SOURCES: PubMed/Embase/PsycINFO/CINAHL databases. STUDY SELECTION: Study inclusion criteria were: 1) primary/peer-reviewed research 2) related to the diagnosis/treatment/recovery of SRC 3) involving school-aged athletes (ages 5-25) 4) with ≥ 25 participants. The search was performed 03/2021 and included only studies published after 03/2013. DATA EXTRACTION: For each article, we looked at whether race/ethnicity were reported, and if so, which races/ethnicities were mentioned. For each race/ethnicity mentioned, we extracted the corresponding sample size and how they were used as variables in the study. DATA SYNTHESIS: Of 4,583 studies screened, 854 articles met inclusion criteria. Of the included articles, 132 (15.5%) reported race of their sample and 65 (7.6%) reported ethnicity, whereas 721 (84.4%) reported neither. When examining the demographic characteristics of the 132 studies that reported race, 69.8% of athletes were reported to be White. Additionally, 79.5% of these studies solely used race as a demographic descriptor as opposed to as a main exposure or covariate of interest. Studies published more recently were more likely to report race. Further, specific study/journal topics and geographic location of the authors were more likely to report race. CONCLUSIONS: Reporting of race/ethnicity is limited in current SRC literature. Future studies should improve the reporting of race/ethnicity, diversify study samples by focusing on enrolling athletes from underrepresented groups, and consider the potential impact of race/ethnicity as social determinants of health on risk factors, recovery, and long-term sequelae after SRC.