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Research Letter: Concussion Evaluation by Injury Setting Among US Children
Todd Burus1, Jennifer D Burus, Svetla Slavova
1Author Affiliations: Department of Internal Medicine (T. Burus), College of Medicine, University of Kentucky, Lexington, Kentucky; Markey Cancer Center, University of Kentucky (T. Burus), Lexington, Kentucky; Department of Outpatient Therapy (J. D. Burus), University of Kentucky Healthcare, Lexington, Kentucky; Department of Biostatistics (Slavova), College of Public Health, University of Kentucky, Lexington, Kentucky; Kentucky Injury Prevention & Research Center, University of Kentucky (Slavova), Lexington, Kentucky; and College of Medicine, University of Kentucky (van Zyl), Lexington, Kentucky.
Insights
Children with concussion symptoms after non-sports-related head trauma (SRHT) are significantly less likely to receive medical evaluation compared to those with sports-related head trauma (SRHT). This results in hundreds of thousands of missed concussion evaluations annually for non-sports-related injuries.
Area of Science:
- Pediatric Traumatic Brain Injury
- Public Health Surveillance
- Healthcare Disparities
Background:
- Concussion is a common injury in children, often resulting from head trauma.
- Medical evaluation is crucial for diagnosing and managing concussion to prevent long-term complications.
- Existing research primarily focuses on sports-related head trauma (SRHT), potentially overlooking non-SRHT injuries.
Purpose of the Study:
- To investigate and quantify disparities in medical concussion evaluation between sports-related head trauma (SRHT) and non-SRHT in US school-aged children.
- To identify factors influencing the likelihood of receiving a concussion evaluation after head trauma.
- To estimate the number of missed concussion evaluations in non-SRHT cases.
Main Methods:
- Utilized data from the National Health Interview Survey (2023-2024), a nationally representative sample of US children aged 5-17 years.
- Caregivers reported on concussion-like symptoms after head trauma in the prior year, injury setting (sports vs. non-sports), and receipt of medical evaluation.
- Statistical analyses, including adjusted prevalence ratios (aPR), were used to compare evaluation rates between SRHT and non-SRHT groups.
Main Results:
- An estimated 2.6% of children experienced concussion-like symptoms after head trauma; most injuries (60.8%) occurred outside of sports.
- Overall, 67.7% of injured children received medical evaluation, with higher rates in males and older children (13-17 years).
- Children with non-SRHT had significantly lower evaluation rates (53.1%) compared to SRHT (90.4%), translating to an estimated 388,905 missed evaluations annually.
Conclusions:
- Substantial disparities exist in concussion evaluation rates, with non-SRHT injuries being significantly under-evaluated compared to SRHT.
- Increased awareness and targeted guidance for concussion recognition and referral in non-sports settings are needed for school personnel and healthcare providers.
- Addressing these evaluation gaps is critical for improving timely diagnosis, appropriate management, and long-term recovery in pediatric concussion patients.
Objective:
To examine differences in medical evaluation for concussion after sports-related head trauma (SRHT) versus non-SRHT among school-aged children in the United States.
Setting:
National Health Interview Survey.
Participants:
Children aged 5-17 years living in the United States.
Design:
Caregiver-reported responses to questions on health topics among a nationally-representative sample of US children.
Main Measures:
Experience of concussion-like symptoms after head trauma in the prior year, injury setting, and receipt of medical evaluation for concussion from health professional.
Results:
The study included 11,768 children aged 5-17 years in 2023-2024. An estimated 2.6% (95% confidence interval [CI], 2.3-2.9) reported concussion-like symptoms after head trauma in the prior year, with a higher prevalence among those aged 13-17 years (3.5%; 95% CI, 3.0-4.1). Most injuries occurred outside of sports settings (60.8%; 95% CI, 54.4-66.8). Overall, 67.7% (95% CI, 61.5-73.5) of injured children received a medical evaluation for concussion. Evaluations were more common among males than females (adjusted prevalence ratio [aPR], 1.249; 95% CI, 1.043-1.495) and those aged 13-17 years than aged 5-12 years (aPR, 1.366; 95% CI, 1.104-1.689). Concussion evaluations were administered to 90.4% of children with SRHT compared with only 53.1% with non-SRHT. Adjusting for relevant characteristics, we estimated medical evaluation occurred 39.2% less often for non-SRHT (aPR, 0.608; 95% CI, 0.505-0.733). Based on the 2023-2024 population estimates, this indicates approximately 388,905 (95% CI, 292,880-484,929) missed concussion evaluations for children with non-SRHT each year.
Conclusion:
These findings suggest substantially more missed concussion evaluations among children with concussion-like symptoms after non-SRHT compared with those with SRHT. Increasing awareness about concussion care among school personnel and health professionals that work with pediatric populations, and embedding clear guidance for referral and treatment into non-sports-related settings, may serve to reduce differences in evaluation and improve long-term recovery.
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