Researchers from the Children’s Hospital of Philadelphia (CHOP) have found that non-Hispanic Black children, as well as those with public insurance and lower Child Opportunity Index (COI) scores, are significantly more likely to seek concussion care in emergency departments rather than in primary or specialty care settings. This research, published today in JAMA Network Open, highlights the urgent need for emergency medicine physicians to receive specialized training in diagnosing and managing pediatric concussions. Additionally, it suggests that enhancing community-level resources could help improve care equity for children with suspected concussions.
Recent studies show that children recovering from concussions benefit from early individualized return-to-activity and rehabilitation plans, which are typically provided by pediatric concussion specialists. However, most children with concussions are treated outside these specialty settings, and access to specialists is not equally available to all families.
Continuing their investigation into health equity and pediatric concussion care, researchers aimed to identify both individual and community-level factors influencing where children first seek help for concussions—whether in emergency rooms, primary care, or specialty care. One key community marker examined is the Child Opportunity Index, which assesses access to essential resources like safe housing, quality schools, nutritious food, parks, and clean air.
Lead author Daniel J. Corwin, MD, who serves as the Director of Clinical and Translational Research in Emergency Medicine at CHOP, noted, “No studies have yet evaluated the differences in individual and community-level factors that might affect where pediatric concussion patients enter the healthcare system. Describing the significant differences we found is a crucial first step toward addressing health equity in pediatric concussion care.”
In this study involving 15,631 pediatric patients with concussions, 4,245 (27.2%) were initially treated in specialty care, 8,417 (53%) in primary care, and 2,969 (19%) in emergency departments. Notably, patients with public insurance and non-Hispanic Black children were much more likely to seek care in the emergency department (52.6% and 50%, respectively), compared to specialty care (8.7% and 16.1%, respectively). Furthermore, the median COI score for those treated in emergency departments was almost three times lower (30 on a scale of 0-100) than those seen in primary or specialty care (median score of 87 for each).
Alexis Peterson, PhD, a co-author and Health Scientist with the CDC’s Traumatic Brain Injury Team, remarked, “Emergency department clinicians often have limited time with patients, making it challenging to tailor concussion rehabilitation to individual needs. Given that many people turn to emergency departments for concussion treatment, we must provide our emergency medicine colleagues with the tools and training needed to offer personalized care, which can enhance recovery.”
Tyra Bryant-Stephens, MD, another co-author and Chief Health Equity Officer at CHOP, added, “Future studies should focus on increasing the capacity of local primary care centers and organizations that serve youth, like schools and recreational programs, to better recognize concussions and provide optimal support for recovery, especially for our most vulnerable children.”
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