Race impacts concussion

Abstract

Over the past decade The Journal of Pediatrics and other journals have published an abundance of studies on youth concussion, often with a focus on sports-related concussion. Pediatricians have thus become increasingly familiar with the diagnosis and management of concussion, and our children have no doubt benefitted from attention to what was a previous neglected injury. But, how well do we understand the mechanism of injury? Do all children suffer the same mechanism for concussion? In this volume of The Journal, Wallace and Mannix present a retrospective, cross-sectional study of emergency department (ED) visits between 2010-2015 by children less than or equal to age 19 for concussion, using the National Hospital Ambulatory Medical Care Survey. Falls were close to twice as common as sports as the underlying mechanism of injury at ED visits. Compared with non-Hispanic White pediatric patient visits for concussion, non-Hispanic Black patients were significantly less likely to present to an ED for concussion. Although assault was a less common mechanism at ED visits compared with falls, sports, and motor vehicle accidents, the odds of non-Hispanic Black and some other race/ethnicity children and adolescents sustaining a concussion from assault was roughly 4-fold higher compared with sport (Table).TablePopulation-weighted frequencies of concussion/MHT by mechanism of injury and race/ethnicity (n = 6 268 879)Mechanisms of injuryNon-Hispanic WhiteNon-Hispanic BlackHispanicOtherSport846 522 (23.4)213 372 (20.2)217 146 (15.4)17 124 (9.6)Motor vehicle collision445 177 (12.3)142 303 (13.5)141 715 (10.1)8474 (4.7)Fall1 495 782 (41.3)407 490 (38.5)816 569 (57.9)98 259 (55.1)Assault125 579 (3.4)131 762 (12.5)11 618 (0.8)12 403 (6.9)Other accident710 238 (19.6)161 791 (15.3)223 224 (15.8)42 331 (23.7)Values are number (%). Open table in a new tab Values are number (%). Although the study data are examined retrospectively, biased possibly by coding in the database, and influenced perhaps by factors affecting how children of different races present to and utilize the ED, the findings regarding the mechanism of injury are nevertheless striking. Youth concussion in the ED is not an injury restricted to children privileged to play organized sports, but instead overwhelmingly an injury from trauma by falls, motor vehicle accidents, and assault. Racial disparities affect the likelihood of the particular underlying mechanism. Youth concussion is much more than a sports phenomenon. Perhaps we should reconsider our allocation of public health resources and research funding for youth concussion. Article page 249 ▸ Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency DepartmentThe Journal of PediatricsVol. 233PreviewTo determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT). Full-Text PDF