PM1079: Post-concussion Academic Performance and Socioeconomic Status

Background: Little research has explored the relationship between socioeconomic status (SES) and post-concussion academic outcomes. The Child Opportunity Index (COI) provides a quantitative score based on residential address, reflecting children's neighborhood-based opportunity. COI considers education, health, environment, and social and economic opportunities. We hypothesize youth with limited access to such resources (lower COI) will have worse academic performance and Neuro-Quality of Life (Neuro-QOL) soon after recovery from their concussion.

Methods: We recruited patients aged 8-17 years presenting to a pediatric sports medicine clinic for concussion between 2014-2017. At enrollment and six months later, participants reported their academic grades and completed a Neuro-QOL survey, which evaluates cognitive effects experienced by children with neurological conditions. Demographics and concussion recovery time were extracted from participants’ EMR. Only participants recovered from their concussion within 6 months of enrollment were included. Residential address determined participant COI score which we categorized as low, high, and very high. Change in academic performance from enrollment to 6 months was categorized as “worse” (-1), “same” (0) or “better” (1). Analyses of variance (ANOVA) compared changes in academic performance and Neuro-QOL across COI groups. P value < 0.05 was significant.

Results: Of 584 participants recruited, 184 (46% male; mean age 14±2) were recovered from their concussion and completed both 6-month surveys. Length of recovery, school year, gender, history of ADHD/ADD, learning disorder, anxiety, or previous concussion did not differ across COI groups (p = 0.83, p = 0.98, p = 0.18, p = 0.20, p = 0.40, p = 0.64, p = 0.36 respectively) thus these variables were not considered in the model. On average, academic performance and Neuro-QOL scores improved slightly from enrollment to 6 months (Figures 1 and 2) and were similar across COI groups (p=0.92 and p=0.22, respectively). However, changes in academic performance and Neuro-QOL varied widely in each group. On average, males showed improvement while females showed worsening of Neuro-QOL scores from enrollment to 6 months (-2.5±22 and 10±16, respectively; p=0.006).

Conclusion: These results suggest changes in academic performance and Neuro-QOL in youth after a concussion are not associated with SES when measured by COI. There was considerable individual variability in academic performance and Neuro-QOL changes for all SES levels. Gender appears to be the main contributor to this variability, as males were more likely to show improvement and females were more likely to show worsening in self-reported academic performance and Neuro-QOL scores.