title: Implication of Socio-Demographics on Cognitive-Related Symptoms in Sports Concussion Among Children.
abstract: BACKGROUND
  Sports-related concussion remains a public health challenge due to its morbidity and mortality. One of the consequences of concussion is cognitive impairment (CI) and cognitive-related symptoms (CRS) which determine, to some extent, physical and behavioral functioning of children who sustain concussion. Despite the high prevalence of CI and CRS associated with concussion, the risk factors are not fully understood. We aimed to characterize CRS and to examine its relationship with race, ethnicity, age, insurance, and sex in a pediatric population.
  
  
  METHODS
  A retrospective cohort (case-only) design was used to assess CRS prevalence and its relationship with race and sex using a pediatric hospital's electronic medical records. A consecutive sample was used with 1429 cases between 2007 and 2014. Study characteristics were examined using chi-square and log binomial regression for hypothesis-specific testing.
  
  
  RESULTS
  Of the 1429 cases, 872 (61.0 %) were boys and 557 (39.0 %) were girls. The racial distribution indicated 1146 (80.2 %) Whites, 170 (11.9 %) Blacks/African Americans, and 113 (7.9 %) others. The prevalence of CRS was 78.0 %. Whereas boys had sustained more concussions, girls were more likely to present with CRS; prevalence risk ratio = 1.07, 95 % CI 1.01-1.13, p = 0.02. The crude analysis indicated no racial disparities in CRS prevalence, but the multivariable analysis did, comparing White to Black/African American children; adjusted prevalence risk ratio (aPRR) = 1.77, 99 % CI 1.02-3.08, p = 0.008.
  
  
  CONCLUSIONS
  Racial disparities exist in CRS among children with sports-related concussion, and Black/African American children are more likely, relative to Whites, to suffer CRS. Due to uncertainty in causal inference, we caution the interpretation and application of these data in risk-adapted concussion prevention.
authors.affiliation: Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA. drholmesjr@gmail.com.|University of Delaware, Newark, DE, 19716, USA. drholmesjr@gmail.com.
authors.forename: Laurens
authors.initials: L
authors.lastname: Holmes
authors.affiliation: University of Delaware, Newark, DE, 19716, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Tworig
authors.affiliation: Villanova University, Villanova, PA, 19085, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Casini
authors.affiliation: Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Morgan
authors.affiliation: Orthopedic Department, Nemours/A. I. duPont Hospital for Children, Wilmington, DE, 19803, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Oceanic
authors.affiliation: Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA.|Orthopedic Department, Nemours/A. I. duPont Hospital for Children, Wilmington, DE, 19803, USA.
authors.forename: Kirk
authors.initials: K
authors.lastname: Dabney