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

Context: The Child Sport Concussion Assessment Tool, fifth edition (Child SCAT5), is among the most widely used international pediatric concussion evaluation tools. However, the tool's English -only aspect may limit its use for patients who speak different languages. Prior researchers have suggested one's preferred language (ie, home language) could be associated with concussion assessments in adults, yet how this might affect pediatric athletes is not well understood. Objective: To compare baseline Child SCAT5 assessment outcomes between middle school athletes whose home language was Spanish and matched control athletes whose home language was English. Design: Case -control study. Setting: Middle school athletics. Patients or Other Participants: Athletes self -reported their home language (ie, language spoken at home). Those indicating their home language was Spanish were individually matched to athletes who spoke English at home on age, sex, sport, school, and pertinent comorbidities (eg, concussion history). The final sample consisted of 144 athletes (Spanish home language = 72, English home language = 72). Main Outcome Measure(s): We used Mann -Whitney U tests to compare the Child SCAT5 component scores of the home language groups (ie, Spanish versus English). Results: Athletes in the Spanish home language group scored lower on the Standardized Assessment of Concussion-Child version ( P < .01, r = -0.25), Immediate Memory ( P < .01, r = -0.45), and total modified Balance Error Scoring System scores ( P < .01, r = -0.25) than 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 than those whose home language was English. These findings may serve as a rationale for the development of future concussion assessment tools to properly capture clinically relevant data regarding language differences among pediatric athletes.