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A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Socioeconomic and demographic considerations of pediatric concussion recovery
James Pate1, Ian Cummins1, James Mooney2
1School of Medicine, University of Alabama at Birmingham, AL, United States.
Insights
This study found that children with concussions treated in specialized clinics were more likely to be white and have private insurance. Public school attendance and psychiatric disorders impacted concussion recovery time.
Area of Science:
- Pediatric Neurology
- Public Health
- Health Services Research
Background:
- Concussion diagnosis and recovery vary significantly among pediatric and adolescent populations.
- Disparities in healthcare access and outcomes exist based on socioeconomic and demographic factors.
- Understanding predictors of concussion recovery is crucial for effective management in youth.
Purpose of the Study:
- To identify predictors of concussion recovery in children versus adolescents.
- To examine economic and demographic disparities in post-concussion care between concussion clinics and emergency departments (ED).
- To analyze factors influencing recovery time, including school type and psychiatric comorbidities.
Main Methods:
- Retrospective cohort review of 1,884 patients (children 5-12, adolescents 13-18) diagnosed with concussion between 2018-2019.
- Data collected on race, insurance status, and treatment setting (concussion clinic vs. ED).
- Analysis of recovery data from a subset of concussion clinic patients to determine time to recovery.
Main Results:
- Concussion clinic patients were more often White and had private insurance compared to ED patients.
- Children had higher hospitalization rates post-concussion than adolescents (40.8% vs. 24.4%).
- Public school attendance correlated with faster recovery (HR 1.8), while psychiatric disorders prolonged recovery (HR 0.5).
Conclusions:
- Findings suggest potential barriers to care for minority and publicly insured youth concussion patients.
- Higher hospitalization rates in young children may warrant reconsidering contact sports participation.
- Concussion recovery is influenced by socioeconomic factors, school environment, and psychiatric health in pediatric populations.
Abstract:
The objective of this study was to investigate predictors of concussion recovery in children (5-12) versus adolescents (13-18) while identifying economic and demographic disparities in post-concussion care at a tertiary referral concussion clinic versus emergency department (ED). Race and insurance status were recorded for patients presenting to the concussion clinic (724) and ED (1,160) with an ICD-10 concussion diagnosis between 2018 and 2019. Secondly, a subset of patients from the concussion clinic group were included for retrospective cohort review based on documented recovery data. Overall, the concussion clinic saw more Caucasian patients (66.7%) than the ED (56.8%). Concussion clinic patients were more likely to have Private insurance than ED patients (67.2% vs. 55.3%) and less likely to have Medicaid and Self pay (p < 0.001). Children were more likely to be hospitalized after concussion diagnosis than adolescents (40.8% vs. 24.4%, p = 0.006). Attending public school was associated with a 1.8 times greater hazard ratio (HR) for shorter time to recovery compared to attending private school. Additionally, presence of a diagnosed psychiatric disorder was associated with a HR of 0.5, indicating a longer time to recovery (p < 0.001) than patients without a disorder. The present findings may support limitations on contact sports participation in young children given their higher hospitalization rate after concussion. Additionally, the study highlights potential barriers to care amongst youth concussion patients with those seen in specialized concussion clinics more likely to be White and have private insurance.
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