Abstract
Background:
An estimated 2.3 million U.S. children have been diagnosed with a concussion or brain injury, yet many cases go unrecognized or unreported, especially when symptoms are mild or overlooked. Timely evaluation by healthcare providers (HCPs) is critical in ensuring accurate diagnosis, appropriate care, and optimal recovery. This study examines national prevalence and child and family factors linked to receiving concussion evaluation by a HCP among children aged 1–17 who experienced concussion symptoms.
Hypothesis:
Symptomatic children's access to concussion evaluation varies by sociodemographics.
Methods:
Data were drawn from the 2020 National Health Interview Survey child data. The analytic sample included children whose parents reported that the child had experienced concussion symptoms—such as loss of consciousness, memory loss, headache, vomiting, blurred vision or changes in mood or behavior—resulting from a blow or jolt to the head, and who had visited a HCP within the past year (n=375, weighted n=4,523,686). The outcome variable was parental-reported receipt of a concussion evaluation for the child by a HCP, as binary (1=received, 0=not received). Adjusted multivariable logistic regression was used to assess associations between receipt of a concussion evaluation and child age, child race, parental education, household income, insurance type, and residence, accounting for the complex survey design.
Results:
A total of 21% of children with concussion symptoms did not receive an evaluation for a concussion from a HCP during their healthcare visit in the past year. Among the children who were evaluated for a concussion by a HCP, 61% (183 out of 295) received a medical diagnosis of concussion. Older children (aOR=1.11, 95% CI=1.03–1.19) were more likely to receive a concussion evaluation from an HCP. Children whose parents had the lowest level of education (aOR=0.20, 95% CI=0.05–0.90) were less likely to receive a concussion evaluation. Child race, insurance type, household income, and residence were not significantly associated with receiving a concussion evaluation from a HCP (all p > 0.05).
Conclusion:
These data inform national estimates of children receiving timely concussion evaluations by HCP. About 1 in 5 symptomatic children are not receiving a concussion evaluation, which may suggest symptoms are being overlooked by HCPs. Improving access to timely evaluation requires public health efforts at all socioecological layers and can be expanded particularly through medical education and community-based education that includes accessible resources for families with younger children. Strengthening public health safety nets and system-level strategies is also essential for ensuring equitable and timely concussion care.