Language Matters: Comparisons of Concussion Assessments Among English and Spanish Speaking Middle School Athletes

Abstract

Context: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) is among the most widely used international pediatric concussion evaluation tools. The tool's English-only development may limit its use for patients who speak different languages. Prior research suggests preferred language (i.e., home language) could be associated with concussion assessments in adults, however this is not well understood among pediatric athletes. Objective: To compare baseline Child SCAT5 assessment outcomes between middle school athletes whose home language is Spanish and matched controls whose home language is English. Design: Case-Control Setting: Middle School Athletics Patients or Other Participants: Athletes self-reported their home language (i.e., “language spoken at home”). Athletes indicating their home language was Spanish were individually matched to athletes that spoke English at home on age, gender, sport, school, and pertinent comorbidities (e.g., concussion history). The final sample included 144 athletes (Spanish home language: n=72, English home language: n=72). Data Collection and Analysis: Mann Whitney U tests compared the home language groups (i.e., 19 Spanish vs English) on the Child SCAT5 component scores. Results: Athletes in the Spanish home language group scored lower on the Standardized Assessment of Concussion – Child version (p<.01, r=−.25), Immediate Memory (p<.01, r=−0.45), and Total Modified Balance Error Scoring System scores (p<.01, r=−0.25) compared to the English home language group. Conclusions: Matched athletes whose home language was Spanish versus English scored differently on baseline Child SCAT5 assessment components. Those with the home language of Spanish scored lower on cognitive and balance tasks compared to those whose home language was English. These findings may serve as rationale for future concussion assessment tools to properly capture clinically relevant data representative language differences among pediatric athletes.