Abstract
Background: Prior studies have shown racial differences in concussion awareness and outcome.Objective: To assess if racial or ethnic differences exist in Emergency Department (ED) utilization and diagnosis for children with sports-related head injuries.Methods: We performed a retrospective, cross-sectional analysis of ED visits from 2008 to 2017 using National Electronic Injury Surveillance System (NEISS) data. Population-weighted ED visits for children age 7–18 years with a sport-related injury were included. We compared the probability of an ED visit being for an injury to the head or diagnosed as a concussion between children of different races/ethnicities. Analyses were adjusted for age, gender, sport, year, and location where the injury occurred.Results: We identified 11,529,994 population-weighted ED visits for pediatric sports-related injuries, of which 1,497,717 (13.0%) were injuries to the head and 619,714 (5.4%) received a diagnosis of concussion. Black children were significantly less likely than non-Hispanic white children to have their ED visit be for an injury to the head [Odds Ratio (OR) 0.72, 95%CI 0.65–0.79] or concussion (OR 0.58, 95%CI 0.50–0.68). Black children presenting to the ED with an injury to their head were less likely than non-Hispanic white children to be diagnosed with a concussion (OR = 0.71, 95%CI 0.59–0.85).Conclusions: Racial differences exist in both ED utilization for pediatric sports-related head injuries and in the diagnosis of concussion. Further work is needed to understand these differences to ensure all brain injured athletes receive optimal care, regardless of race.
Highlights
Sports-related injuries are one of the most common causes of head injuries and concussions in children in the United States [1, 2]
These visits correspond to 11,529,994 population-weighted Emergency Department (ED) visits, including 1,497,717 (13.0%) visits for injuries to the head region and 619,714 (5.4%) visits for injuries diagnosed as concussions (Table 1)
We found no association between not reporting race/ethnicity and ED visits for injuries to the head region [Odds ratio (OR): 1.05, 95%confidence intervals (CI) 0.91–1.22] or injuries diagnosed as concussions (OR: 0.97, 95%CI 0.74–1.26)
Summary
Sports-related injuries are one of the most common causes of head injuries and concussions in children in the United States [1, 2]. There have been significant efforts to increase awareness and recognition of sports-related head injuries, as well as to define protocols for concussion management and return-to-play guidelines [7, 8]. The identification of patients with sports-related head injuries and concussion has important implications for how young athletes, parents, and coaches approach return to play, rehabilitation, as well as the long-term risks/benefits of continued sports participation after a sports-related head injury. The Emergency Department (ED) represents a common location of initial evaluation of sports-related head injuries and concussions for children, with ED visits for young athletes increasing [1, 11]. Prior studies have shown racial differences in concussion awareness and outcome
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