Disparities identified in health care system point of entry for pediatric concussion care

Children’s Hospital of Philadelphia (CHOP) researchers have identified a key disparity in pediatric concussion care, specifically impacting children who are non-Hispanic Black, possess public insurance and have lower Child Opportunity Index (COI) scores. More than other children, patients in these parameters were found to seek initial care for concussions in the emergency department, rather than in primary or specialty care settings.

The group’s findings, published in The Journal of the American Medical Association (JAMA), emphasize the importance of ensuring that emergency medicine physicians receive proper training and education relevant to the diagnosis and management of pediatric concussions. These measures, along with establishing up-to-date community resources, could improve equity and quality of care for children with suspected concussions.
Researchers were interested in individual- and community-level characteristics that could contribute to the determination of the point of entry that patients with concussions use to enter the health care system. They landed on the COI, which combines key environmental factors that shape a child’s life experiences and opportunities into a single measure.

“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 health care system for pediatric concussion,” Daniel J. Corwin, M.D., attending physician, director of clinical and translational research in the Division of Emergency Medicine and associate director, emergency department lead of the Minds Matter Concussion Program at CHOP, said in a news release. “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.”

Children who sustain concussions recover quicker when they’re returned to activities and prescribed active rehabilitation early in the recovery process, according to research. That said, these treatment approaches are often prescribed by pediatric concussion specialists, and not all pediatric concussion patients have equal and timely access to concussion specialists.

In the study of 15,631 pediatric concussion patients, 4,245 of them were first seen in a specialty care setting, 8,417 of them were first seen in the primary care setting and 2,969 began in the emergency department. According to the study, children with public insurance, and non-Hispanic Black children, were significantly more likely to first seek care in the emergency department, with 52.6% of patients with public insurance, and 50% of non-Hispanic Black patients, beginning their treatment in the emergency department. Patients who initially sought treatment in the emergency department had an average COI nearly three times lower than patients who began in specialty or primary care.

“Emergency department clinicians often have limited time with patients, and it may be challenging to tailor concussion rehabilitation approaches to the individual,” Alexis Peterson, Ph.D., co-author of the study, and health scientist on the Traumatic Brain Injury Team at the Centers for Disease Control and Prevention (CDC), said. “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.”

The researchers emphasized the importance of increasing access to primary care and stressed the necessity for further research. “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,” Tyra Bryant-Stephens, M.D., chief health equity officer of the Center for Health Equity at CHOP, explained.