Children with assault-related concussion have worse outcomes and are less-likely to get proper evaluation than those with sport-related concussion

By Malayka Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.

A study by Margaret J Means et al., published in Pediatric Emergency Care, found significant disparities in diagnosis and outcomes between children presenting to a pediatric hospital with assault-related (ARC) and sports-related concussion (SRC). Lead author Margaret Means, quoted in a CHOP News article by Ben Leach, highlights that providers may not think of concussions as a possibility when patients present with assault. “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.” For example, only 27% of ARC patients received a visio-vestibular examination in their initial visit, compared to 74% of SRC patients. 

The study reviewed charts of 62 SRC and 62 ARC patients aged 8-17 who received a concussion diagnosis when presented to the hospital. “Patients with ARC were more likely to be Black, publicly insured, and present first for care to the emergency department.” While symptom presentation did not differ between the two groups, more than twice as many ARC patients reported a drop in grades as SRC patients (47% vs. 20% of patients). The authors found additional trends for ARC patients indicating increased rates of prolonged symptom recovery and increased time to a full return to activities, though these differences between the two groups were not statistically significant. The authors hope that this research will spur further investigation into care inequities related to concussions from assault and other non-sport causes.