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Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective
John K Yue1, Nishanth Krishnan1, John P Andrews1
1Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
Insights
Pediatric mild traumatic brain injury (MTBI) is more common in rural and underserved areas, leading to worse outcomes due to healthcare access barriers. Improving community awareness and utilizing telehealth can enhance care for children with MTBI.
Area of Science:
- Pediatric neurology
- Public health
- Healthcare disparities
Background:
- Mild traumatic brain injury (MTBI) significantly impacts children globally, with unique vulnerabilities in pediatric populations.
- Rural and underserved communities face substantial barriers to accessing adequate healthcare for pediatric MTBI.
- A current knowledge update is essential to address care gaps and develop targeted interventions for pediatric MTBI.
Purpose of the Study:
- To review current literature on pediatric mild traumatic brain injury (MTBI) in rural and underserved populations.
- To identify key challenges and potential solutions in managing pediatric MTBI in resource-limited settings.
- To explore the role of telehealth in improving care delivery for pediatric concussion.
Main Methods:
- A systematic literature search of the PubMed database was conducted using specific keywords related to MTBI, rural/underserved populations, and pediatrics.
- Fifteen relevant articles published through December 2022, focusing on rural/underserved pediatric MTBI not previously reviewed, were analyzed.
- The selected articles were categorized into epidemiology, care practices, socioeconomic factors, and telehealth.
Main Results:
- Pediatric MTBI incidence is higher in rural areas, among minorities, and in younger children (0-4 years), with increasing trends.
- Rural healthcare utilization for MTBI often favors emergency departments, and management guidelines need adaptation for resource-constrained environments.
- Lower parental education and income correlate with reduced MTBI knowledge and poorer outcomes; telehealth shows promise for improving care in remote settings.
Conclusions:
- Children with MTBI in rural/underserved areas face elevated injury risks and significant healthcare access barriers, resulting in poorer outcomes.
- Under-reporting of pediatric MTBI globally hampers epidemiological understanding; community education for caregivers and schools is crucial.
- Telehealth interventions are feasible and effective for improving pediatric MTBI care delivery across various settings, warranting integration into triage and treatment protocols.
Background:
Mild traumatic brain injury (MTBI) causes morbidity and disability worldwide. Pediatric patients are uniquely vulnerable due to developmental and psychosocial factors. Reduced healthcare access in rural/underserved communities impair management and outcome. A knowledge update relevant to current gaps in care is critically needed to develop targeted solutions.
Methods:
The National Library of Medicine PubMed database was queried using comprehensive search terms (("mild traumatic brain injury" or "concussion") and ("rural" or "low-income" or "underserved") and ("pediatric" or "child/children")) in the title, abstract, and Medical Subject Headings through December 2022. Fifteen articles on rural/underserved pediatric MTBI/concussion not covered in prior reviews were examined and organized into four topical categories: epidemiology, care practices, socioeconomic factors, and telehealth.
Results:
Incidences are higher for Individuals in rural regions, minorities, and those aged 0-4 years compared to their counterparts, and are increasing over time. Rural healthcare utilization rates generally exceed urban rates, and favor emergency departments (vs. primary care) for initial injury assessment. Management guidelines require customization to resource-constrained settings for implementation and adoption. Decreased community recognition of the seriousness of injury is a consensus challenge to care provision by clinicians. Low parental education and income were correlated with decreased MTBI knowledge and worse outcome. Telehealth protocols for triage/consultation and rehabilitation were feasible in improving care delivery to rural and remote settings.
Conclusions:
Pediatric MTBI/concussion patients in rural/underserved regions experience increased risks of injury, geographic and financial healthcare barriers, and poorer outcomes. Globally, under-reporting of injury has hindered epidemiological understanding. Ongoing MTBI education should be implemented for rural caregivers, schools, and low-income populations to improve community awareness. Telehealth can improve care delivery across acuity settings, and warrants judicious inclusion in triage and treatment protocols.
