Non-Hispanic Black children and low-income youth disadvantaged in concussion care

Researchers from Children’s Hospital of Philadelphia (CHOP) found that non-Hispanic Black children and those with public insurance and lower Child Opportunity Index (COI) scores were much more likely to seek care for concussions in the emergency department than in primary care or specialty care settings. The findings underscore the need to ensure emergency medicine physicians have specific training and education for diagnosing and managing pediatric concussion and suggest that establishing up-to-date community-level resources could improve care equity for children with possible concussion. The findings were published today by JAMA Network Open.

Recent research has demonstrated that children who sustain a concussion have a faster recovery when individualized return-to-activity and active rehabilitation approaches are prescribed early, and these strategies are almost exclusively recommended by pediatric concussion specialists. However, most pediatric patients with concussion are typically cared for outside of specialty settings, and not everyone has equal and timely access to concussion specialists.

Continuing a line of work investigating health equity and pediatric concussion and potential disparities in outcomes, researchers wanted to describe both individual- and community-level characteristics that could be associated with the point of entry – either in the emergency room, primary care, or specialty care – that patients with concussion use to enter the healthcare system. An important community-level marker is the Child Opportunity Index – which measures and maps the quality of access to safe housing, quality schools, healthy food, parks and clean air, among other factors.

“To date, no studies have evaluated differences in both individual- and community-level markers of opportunity and vulnerability that may exist across different points of entry into the healthcare system for pediatric concussion,” said lead study author Daniel J. Corwin, MD, an attending physician and Director of Clinical and Translational Research in the Division of Emergency Medicine and Associate Director and Emergency Department Lead of the Minds Matter Concussion Program at CHOP. “Being able to adequately describe the significant differences we found in this study is a critical first step to addressing health equity in pediatric concussion.”

In this study of 15,631 pediatric patients with concussion, 4,245 (27.2%) were initially seen in the specialty care setting, 8,417 (53%) in the primary care setting and 2,969 (19%) in the emergency department. However, those with public insurance and non-Hispanic Black patients were significantly more likely to first seek care the emergency department (52.6% and 50%, respectively) compared with specialty care (8.7% and 16.1%, respectively). Additionally, the median overall COI score was almost three times lower for patients initially seen in the emergency department (median score of 30 on a 0-100 scale) compared with both primary and specialty care (median score 87 for each).

“Emergency department clinicians often have limited time with patients, and it may be challenging to tailor concussion rehabilitation approaches to the individual,” said Alexis Peterson, PhD, study co-author and Health Scientist on the Traumatic Brain Injury Team at the Centers for Disease Control and Prevention (CDC). “Since we know that many people seek treatment for concussions in emergency departments, we need to equip our emergency medicine colleagues with tools and training to help them offer individualized care, which improves recovery.”

“Future studies are needed to determine how to increase capacity of neighborhood primary care centers and organizations that serve youth, such as schools and recreational and after-school programs, so they can better recognize potential concussions and provide optimal support during recovery for our more vulnerable youth,” said study co-author Tyra Bryant-Stephens, MD, Chief Health Equity Officer of the Center for Health Equity at CHOP.