Researchers from the Minds Matter Concussion Program and the Center for Violence Prevention at Children's Hospital of Philadelphia (CHOP) have identified important differences in the initial evaluation and outcomes between patients who suffered a concussion as the result of assault compared with those who suffered a concussion sustained during sports. Specifically, patients who suffered an assault-related concussion were less likely to receive concussion-specific testing upon diagnosis, had prolonged recovery trajectories, and were more than twice as likely to experience a decline in school performance. The findings were published online in the journal Pediatric Emergency Care.
This study represents the first to show that there are important disparities in concussion diagnosis and outcomes between children and adolescents who sustain concussions from an assault-related mechanism compared with sports-related injuries.
Most studies about concussion diagnosis and recovery have focused on sports-related concussions. However, about 30% of concussions are caused by other factors, including assaults, falls, and motor vehicle crashes. Despite these statistics, no studies to date have compared assault-related with sport-related concussions in terms of their assessments, recovery timelines, and clinical outcomes.
Margaret Means, MD "Given the current research and clinical focus on sports-related concussions, when a patient seeks care following an assault, providers may not necessarily have concussion at the top of their minds," said Margaret Means, MD, a child neurology resident in the Division of Neurology at CHOP and lead author of the study. "In addition, much of the education and awareness surrounding concussion has focused on sport-related concussion and, as a result, clinicians caring for non-sports-related mechanisms of injury may not think of approaching assault-related concussion in the same way. The implications of this study are quite important to ensure equitable care for concussion patients."
In this retrospective study, the researchers conducted a chart review of 124 patients, with 62 patients who suffered from an assault-related concussion and 62 who suffered from a sports-related concussion. Patients were between the ages of 8 and 17, seen at CHOP over a period of two years between 2012 and 2014, and received a concussion diagnosis at the time they presented at the hospital.
The study found that patients who had sustained an assault-related concussion were more likely to be Black and publicly insured and present to the emergency department for their diagnosis. Additionally, fewer patients with assault-related concussions received a concussion specific visio-vestibular examination at their initial visit (27% vs 74%, p p = 0.012). Additionally, there was evidence that patients who suffered from assault-related concussions took longer to recover from concussion symptoms and receive clearance from their doctors for a full return to activities.
Rachel K. Myers, PhD "From our violence prevention work, we are well aware of the large number of children and adolescents who experience concussions as a result of violence and may not have access to the same levels of support as youth who experience sport-related concussion," said co-author Rachel Myers, PhD, MS, co-director of the Community Violence and Trauma Support programming at the Center for Violence Prevention at CHOP. "Understanding the possible disparities in diagnosis, treatment, and recovery is vitally important in enhancing our efforts to support violently injured youth's physical and psychosocial recovery."
Daniel J. Corwin, MD, MSCE "These results support the idea of creating standardized evaluation tools, including symptom assessment and visio-vestibular testing, for all patients presenting with head injuries, regardless of injury mechanism," said senior author Daniel J. Corwin, MD, MSCE, Assistant Professor of Pediatrics at the University of Pennsylvania and Associate Director of Research for the Division of Emergency Medicine at CHOP. "In particular, routine visio-vestibular testing has the potential to improve diagnostic accuracy and tailor the anticipatory guidance of providers in predicting recovery. Its routine use is a valuable tool in minimizing care disparities."
The authors believe these findings will prompt prospective research to establish and evaluate interventions to reduce disparities in care delivery and recovery, including a focus on enhancing timely diagnosis, school re-integration, and recovery support to address psychosocial challenges experienced during recovery from assault-related concussion in the same way that those with sports-related concussion are supported.
Means et al, "Assault-related concussion in a pediatric population." Pediatr Emerg Care. Online March 1, 2022. DOI: 10.1097/PEC.0000000000002664.
