Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population.
Fairuz N Mohammed, Christina L Master, Kristy B Arbogast and 4 others
PMID 36731016WHAT IT FOUND
80.5% of children completed the recommended follow-up care, but non-Hispanic Black children and children with public insurance/self-pay were less likely to continue until clearance.
No-show and specialty visit rates did not differ.
Key findings
01In 755 patients aged 5-18 years, 80.5% were adherent to follow-up recommendations.
02Public insurance/self-pay and non-Hispanic Black patients were less likely to adhere than private insurance and non-Hispanic White patients, including after adjustment.
03The gap was mainly in continuing follow-up until provider clearance; no differences were found for no-show visits or attending a referred specialty visit.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study looked at one children's hospital network over a selected time period, so it may not show what happens in other places or other times. It used existing records, so it cannot prove that race or insurance caused lower adherence; these factors are markers for broader social and system barriers. Patients with missing or unknown race/ethnicity, insurance, or injury mechanism were excluded from the adjusted analysis, which may change the estimates. Follow-up outside the hospital network could not always be seen, so some patients may have received care elsewhere. Not every visit used the standardized concussion template, and electronic health record data on demographics and visits may be incomplete or inaccurate. The study did not measure transportation, cost, school support, provider bias, or family circumstances, so it cannot say why the gap occurred.
Declared interests
The supplied text does not include a specific author conflict-of-interest statement. The publication types list NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read the lower adherence rates as proof that these families are noncompliant or that race or insurance caused the difference. The study is observational and reports an association, and the authors state that race and insurance are proxies for broader social and system factors.