P2B013: Association of Community Characteristics and Patient Socio-demographics with Setting of Care for Pediatric Concussion

Background: Concussion is a common childhood injury characterized by a broad range of mechanisms, time to presentation and symptom profiles. As a result, there are numerous points of healthcare entry for concussion patients that range from emergency/urgent care, primary care or specialty care. Previous research has identified disparities by race, ethnicity, income, and education in concussion recovery and outcomes. Understanding where different socio-demographic groups access concussion care is a first step in developing strategies to improve health equity. The objective of this analysis was to use a concussion registry from a broad children’s hospital healthcare network to identify differences in initial setting of healthcare access by key socio-demographic features of the injured child and their community.

Methods: Using the Minds Matter Concussion Registry, we queried data of children, aged 0-18 years, diagnosed with a concussion, and seen between January 2017 and March 2023 in either the emergency department (ED), urgent care (UC), primary care (PC), or specialty care (SC) settings. Differences in initial setting of healthcare were analyzed by patient age, sex, race/ethnicity, and insurance status as well as the following metrics associated with patient zip code: median family income and proportion of residents age 25+ with >Bachelor’s Degree. The median Child Opportunity Index national normed score was calculated for the patient cohort seen in each healthcare setting. Categorical and quantitative variables were compared across settings by Pearson's Chi-squared test and Kruskal-Wallis rank sum test, respectively.

Results: During the study time frame, 16,105 patients with concussion, age 0-18 years, were seen in the network: 43.7% had initial visits in PC, 25.6% in SC, 20.7% in ED, and 10.0% in UC. Patients in ED and UC were younger than PC and SC. (Table 1) A greater proportion of boys (vs girls), and non-Hispanic blacks (vs Hispanics and non-Hispanic whites) were seen in the ED. Characteristics of the patient’s community varied by healthcare setting with those seeking initial care in the ED coming from lower opportunity communities. (Table 2)

Conclusion: Non-Hispanic black youth, who come from communities impacted by systemic and structural racism resulting in limited resources, as well as their male and publicly insured peers, appear to be more likely to seek initial concussion care in the ED compared to other settings. This finding, coupled with prior research showing care delivered for concussed youth in emergency care settings can be negatively impacted by competing acute needs and limited follow-up, suggests the least resourced children seek concussion care in settings with the greatest challenge delivering comprehensive resources. Equipping ED and UC providers with easy-to-use assessments and educational tools, as well as encouraging concussed youth to seek care with pediatricians and family practice providers may improve equity in recovery and outcomes.