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Patterson Gentile C, Rosenthal S, Blume H, Rastogi RG, McVige J, Bicknese A, Ladak A, Zaveri H, Greene K, Barlow K. American Headache Society white paper on treatment of post-traumatic headache from concussion in youth. Headache 2024. [PMID: 39073141 DOI: 10.1111/head.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury. BACKGROUND Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. METHODS This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. RESULTS Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. CONCLUSIONS This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth.
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Affiliation(s)
- Carlyn Patterson Gentile
- Division of Pediatric Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott Rosenthal
- Department of Pediatrics - Neurology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Heidi Blume
- Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Reena Gogia Rastogi
- Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Jennifer McVige
- Pediatric Neurology, Pediatric and Adult Headache, Dent Neurologic Institute, Amherst, New York, USA
| | - Alma Bicknese
- Division of Pediatric Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali Ladak
- Division of Pediatric Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Harshul Zaveri
- Division of Child Neurology, Children's Hospital of Orange County, UC Irvine School of Medicine, Orange, California, USA
| | - Kaitlin Greene
- Division of Pediatric Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Karen Barlow
- Children's Hospital and Health Services, University of Queensland, Brisbane, Queensland, Australia
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Cook NE, Kissinger-Knox A, Iverson IA, Stephenson K, Norman MA, Hunter AA, Saadi A, Iverson GL. Social Determinants of Health and Health Equity in the Treatment and Rehabilitation of Sport-Related Concussion: A Content Analysis of Intervention Research and Call-To-Action. J Neurotrauma 2024. [PMID: 38753708 DOI: 10.1089/neu.2023.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
This review was designed to (1) determine the extent to which the clinical science on sport-related concussion treatment and rehabilitation has considered social determinants of health (SDoH) or health equity and (2) offer recommendations to enhance the incorporation of SDoH and health equity in concussion treatment research and clinical care. The Concussion in Sport Group consensus statement (2023) was informed by two systematic reviews examining prescribed rest or exercise following concussion and targeted interventions to facilitate concussion recovery. We examined 31 studies, including 2,698 participants, from those two reviews. Race (k = 6; 19.4%) and ethnicity (k = 4; 12.9%) of the study samples were usually not reported. Four studies examined ethnicity (i.e., Hispanic), exclusively as a demographic category. Five studies (16.1%) examined race as a demographic category. Three studies (9.7%) examined socioeconomic status (SES; measured as household income) as a demographic category/sample descriptor and one study (3.2%) examined SES in-depth, by testing whether the treatment and control groups differed by SES. Five studies examined an SDoH domain in a descriptive manner and four studies in an inferential/intentional manner. No study mentioned SDoH, health equity, or disparities by name. Many studies (61.3%) excluded participants based on demographic, sociocultural, or health factors, primarily due to language proficiency. The new consensus statement includes recommendations for concussion treatment and rehabilitation that rely on an evidence base that has not included SDoH or studies addressing health equity. Researchers are encouraged to design treatment and rehabilitation studies that focus specifically on underrepresented groups to determine if they have specific and unique treatment and rehabilitation needs, whether certain practical modifications to treatment protocols might be necessary, and whether completion rates and treatment adherence and response are similar.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Concussion Research Program, Spaulding Hospital Cambridge, Cambridge, MA, USA
| | - Ila A Iverson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Katie Stephenson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Marc A Norman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Amy A Hunter
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Injury Prevention Center, Connecticut Children's Medical Center and Hartford Hospital, Hartford, CT, USA
| | - Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Concussion Research Program, Spaulding Hospital Cambridge, Cambridge, MA, USA
- Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
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Ingram BM, DeFreese JD, Kerr ZY, Oyesanya TO, Picha KJ, Register-Mihalik JK. Applying the National Institute on Minority Health and Health Disparities Research Framework to Social Determinants of Health in the Context of Sport-Related Concussion: A Clinical Commentary. J Athl Train 2024; 59:447-457. [PMID: 38446622 PMCID: PMC11127672 DOI: 10.4085/1062-6050-0370.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Sport-related concussion (SRC) is a prevalent injury. Significant disparities in SRC outcomes exist across racial and ethnic groups. These disparities may be attributed to the unequal distribution of political power (or influence) and resource allocation in various communities, shaping individuals' social determinants of health (SDOH). However, the influence of SDOH on SRC outcomes remains understudied. In this clinical commentary, we use the National Institute on Minority Health and Health Disparities Research Framework and describe how its application can help address gaps in our understanding of SDOH and SRC. This framework provides a comprehensive approach to investigating and addressing health disparities by considering SDOH along multiple levels and domains of influence. Using this framework, athletic trainers can identify areas requiring intervention and better understand how SDOH influence SRC outcomes. This understanding can help athletic trainers develop tailored interventions to promote equitable care for patients with SRC.
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Affiliation(s)
- Brittany M. Ingram
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kelsey J. Picha
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
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Jo J, Williams KL, Wallace J, Anand M, Anesi T, Brewer C, Burns C, Hefley WF, St Julien Z, Tang AR, Zuckerman SL, Terry DP, Yengo-Kahn AM. Systematic Review Examining the Reporting of Race and Ethnicity in Sport-Related Concussion Studies. J Athl Train 2024; 59:354-362. [PMID: 37347141 PMCID: PMC11064120 DOI: 10.4085/1062-6050-0072.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Sport-related concussion (SRC) is an evolving public health concern among youth athletes. Despite emerging evidence that race and ethnicity are important factors in determining concussion outcomes, studies examining race and ethnicity are limited. We conducted a systematic review to (1) determine the prevalence of SRC studies in which participants' race or ethnicity is reported, (2) describe how race and ethnicity are used within each study, and (3) assess predictive factors for the reporting of race and ethnicity. DATA SOURCES PubMed, Embase, PsycINFO, and CINAHL databases. STUDY SELECTION Study inclusion criteria were (1) primary and peer-reviewed research; (2) related to the diagnosis, treatment, or recovery of SRC; (3) involving school-aged athletes (ages 5 to 25); and (4) with 25 or more participants. The search was performed in March 2021 and included only studies published after March 2013. DATA EXTRACTION For each article, we looked at whether race and ethnicity were reported, and if so, which races or ethnicities were mentioned. For each race or ethnicity mentioned, we extracted the corresponding sample size and how they were used as variables in the study. DATA SYNTHESIS Of 4583 studies screened, 854 articles met inclusion criteria. Of the included articles, 132 (15.5%) reported race, and 65 (7.6%) reported ethnicity, whereas 721 (84.4%) reported neither. When examining the demographic characteristics of the 132 studies that reported race, 69.8% of athletes were White. Additionally, 79.5% of these studies used race solely as a demographic descriptor as opposed to a main exposure or covariate of interest. Studies published more recently were more likely to report race. Further, studies in specific study or journal topics and specific geographic locations of the authors were more likely to report race. CONCLUSIONS Reporting of race and ethnicity is limited in current SRC literature. Future authors should improve the reporting of race and ethnicity, diversify study samples by focusing on enrolling athletes from underrepresented groups, and consider the potential effect of race and ethnicity as social determinants of health on risk factors, recovery, and long-term sequelae after SRC.
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Affiliation(s)
- Jacob Jo
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Kristen L Williams
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica Wallace
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa
| | - Malini Anand
- Vanderbilt University School of Medicine, Nashville, TN
| | - Trevor Anesi
- Vanderbilt University School of Medicine, Nashville, TN
| | - Claire Brewer
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa
| | | | | | | | - Alan R Tang
- Vanderbilt University School of Medicine, Nashville, TN
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Douglas P Terry
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Aaron M Yengo-Kahn
- Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
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Middleton KK, Turner A. Racial and Ethnic Disparities in Sports Medicine and the Importance of Diversity. Clin Sports Med 2024; 43:233-244. [PMID: 38383106 DOI: 10.1016/j.csm.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Within orthopedics surgery as a specialty, sports medicine is one of the least diverse surgical subspecialties. Differences in minority representation between patient and provider populations are thought to contribute to disparities in care, access, and outcomes.
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Affiliation(s)
| | - Alex Turner
- University of Texas Southwestern Medical School, Dallas, TX, USA
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6
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Charleston L, Posas J. Categorizing Sports-Related Concussion Disparities by Key Domains of Social Determinants of Health. Curr Pain Headache Rep 2024; 28:125-132. [PMID: 38227210 DOI: 10.1007/s11916-023-01187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW To explore recently published data on disparities in concussion and best categorize these data into domains of social determinants of health (SDOH). RECENT FINDINGS Disparities in concussion cover a range of SDOH domains. Questions on disparities in concussion remain. Interventions to reduce these disparities and inequities are needed. Social determinants of health may play a significant role in disparities and inequities in sports related concussion. There is interplay and overlap in SDOH domains that affect concussion outcomes. It is possible that an increase in SDOH may affect concussion disparities by moderated mediation; however, further data is needed to validate this potential effect. Moreover, attention to SDOH domains in sports related concussion may provide insight on intervention targets to ameliorate disparities in sports related concussion.
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Affiliation(s)
- Larry Charleston
- Department of Neurology, Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Jose Posas
- Oschner Health Neuroscience Institute, New Orleans, LA, USA
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Domena AM, Rosenblum DJ, Donahue CC, Resch JE. The Influence of Race on Time to Symptom Resolution Following Sport Concussion in Collegiate Athletes. J Sport Rehabil 2024:1-6. [PMID: 38335953 DOI: 10.1123/jsr.2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Abstract
CONTEXT Race has been shown to influence computerized neurocognitive test scores, motor function test scores, and reported symptomology following sport-related concussion (SRC). However, the effect race may have on recovery time following SRC remains unknown. The objective of this study was to determine the influence of race on days until symptom free from SRC in NCAA Division 1 collegiate athletes. DESIGN Prospective cohort study. METHODS Participants were Black (n = 53 [28% female]) and White (n = 150 [43.3% female]) who were on average 19.0 (1.21) and 20.2 (1.3) years of age, respectively. Data were collected from the 2015-2016 to 2020-2021 collegiate sport seasons. Participants were evaluated before and after an SRC at empirically derived time points. The primary outcome measure was time until symptom free (days). Additional outcomes included baseline and postinjury Immediate Postconcussion Assessment and Cognitive Test and Sensory Organization Test (SOT) scores. A Mann-Whitney U test compared days to symptom free between groups. Immediate Postconcussion Assessment and Cognitive Test and SOT outcome scores were analyzed using a 2 (group) × 2 (time) analysis of variance. RESULTS White participants had a longer median recovery time (9 d) to symptom free compared with Black participants (6 d [P = .04]). Statistically significant differences were observed between Black 87.3 (9.84) and White 90.4 (8.30) groups for Immediate Postconcussion Assessment and Cognitive Test's verbal memory composite score (P = .03). Postinjury, White participants scored significantly higher 44.5 (5.63) on visual motor speed compared with Black participants (42.4 (5.90) [P = .02]). Within-group SOT differences between baseline and postinjury testing were observed in both groups (all P < .001). CONCLUSIONS Black collegiate athletes achieved symptom resolution sooner than White athletes. We did not explore underlying sociocultural factors such as socioeconomic status or previous concussion education, which may have influenced our results. Future studies should explore factors that may contextualize these findings.
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Affiliation(s)
- Angelina M Domena
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Catherine C Donahue
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Kliethermes SA, Asif IM, Blauwet C, Christensen L, Coleman N, Lavallee ME, Moeller JL, Phillips SF, Rao A, Rizzone KH, Sund S, Tanji JL, Tuakli-Wosornu YA, Stafford CD. Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review. Br J Sports Med 2024; 58:164-171. [PMID: 38216322 PMCID: PMC10961938 DOI: 10.1136/bjsports-2023-107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base. DESIGN Scoping review. DATA SOURCES Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials. ELIGIBILITY CRITERIA Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included. RESULTS 103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90). CONCLUSION Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.
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Affiliation(s)
- Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Irfan M Asif
- Family and Community Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Leslie Christensen
- Department of Library Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nailah Coleman
- Pediatric Primary Care, Children's National Hospital, Washington, District of Columbia, USA
| | - Mark E Lavallee
- Department of Orthopedics, UPMC, Harrisburg, Pennsylvania, USA
| | - James L Moeller
- Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Shawn F Phillips
- Department of Family and Community Medicine, Penn State Health, Mount Joy, Pennsylvania, USA
| | - Ashwin Rao
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine H Rizzone
- Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Sund
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Jeffrey L Tanji
- Orthopedics, UC Davis Sports Medicine, Sacramento, California, USA
| | - Yetsa A Tuakli-Wosornu
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Cleo D Stafford
- Department of Orthopaedics and Rehabilitations Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Loftin MC, Zynda AJ, Pollard-McGrandy A, Eke R, Covassin T, Wallace J. Racial differences in concussion diagnosis and mechanism of injury among adults presenting to emergency departments across the United States. Brain Inj 2023; 37:1326-1333. [PMID: 37607067 DOI: 10.1080/02699052.2023.2248581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the association between race and concussion diagnosis as well as the association between race and mechanism of injury (MOI) for concussion diagnoses in adult patients (>19 years old) visiting the emergency department (ED). METHODS A retrospective analysis of patient visits to the ED for concussion between 2010 and 2018, using the National Hospital Ambulatory Medical Care Survey, was conducted. Outcome measures included concussion diagnosis and MOI. Multivariable and multinomial logistic regression analyses were conducted to assess associations between race and outcome variables. The results were weighted to reflect population estimates with a significance set at p < 0.05. RESULTS Overall, 714 patient visits for concussions were identified, representing an estimated 4.3 million visits nationwide. Black adults had lower odds of receiving a concussion diagnosis [p < 0.05, Odds Ratio (OR), 0.54; 95% Confidence Interval (CI), 0.38-0.76] compared to White adults in the ED. There were no significant differences in MOI for a concussion diagnosis by race. CONCLUSION Racial differences were found in the ED for concussion diagnosis. Disparities in concussion diagnosis for Black or other minoritized racial groups could have significant repercussions that may prolong recovery or lead to long-term morbidity.
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Affiliation(s)
- Megan C Loftin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Aaron J Zynda
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | | | - Ransome Eke
- Department of Community Medicine, School of Medicine, Mercer University, Columbus, Georgia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama, USA
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Boltz AJ, Memmini AK, Brett BL, Snedden TR, Yengo-Kahn AM, Chandran A, Conway DP, Shah R, Pasquina PF, McAllister TW, McCrea MA, Master CL, Broglio SP. Intersection of Race and Socioeconomic Status on Concussion Recovery among NCAA Student-Athletes: A CARE Consortium Study. Med Sci Sports Exerc 2023; 55:2180-2193. [PMID: 37486776 DOI: 10.1249/mss.0000000000003258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE The objectives of this study are to 1) describe collegiate student-athlete (SA) race and household income and 2) evaluate time to normal academic performance (i.e., return to learn (RTL)), initiation of the return to play (iRTP) protocol, RTP protocol duration, and time to unrestricted RTP (URTP) after sustaining sport-related concussion (SRC). METHODS Data were collected between 2014 and 2020 by the Concussion Assessment, Research, and Education Consortium. Baseline data were used to characterize participant demographics ( N = 22,819) and post-SRC outcomes ( n = 5485 SRC) in time to RTL ( n = 1724) and RTP outcomes ( n = 2646) by race. Descriptive statistics and nonparametric tests examined differences across race by demographic and injury characteristics. Kaplan-Meier curves estimated median days to RTL, iRTP protocol, RTP protocol completion, and URTP by race and covariate measures. Multivariable Cox proportional hazards regression assessed the effect of race on risk of RTL and RTP recovery time points. RESULTS SA largely identified as White (75%) followed by Black (14%), multiracial (7%), and Asian (3%). More than half (53%) of all SA reported a household income of >$120,000, whereas 41% of Black SA reported a household income <$60,000. Race was not associated with relative risk of RTL or iRTP but was associated with RTP protocol completion and URTP. Non-Black/non-White SA were 17% less likely (adjusted hazard ratio = 0.83; 95% confidence interval = 0.71, 0.97) to complete the RTP protocol, and Black SA were 17% more likely (adjusted hazard ratio = 1.17; 95% confidence interval = 1.05, 1.31) to reach the URTP time point compared with White SA. CONCLUSIONS The present findings suggest collegiate SA enrolled in the Concussion Assessment, Research, and Education Consortium are primarily White and come from household incomes well above the US median. Race was not associated with RTL or iRTP but was associated with RTP protocol duration and total time to URTP. Clinicians should be conscientious of how their implicit or preconceived biases may influence SRC management among National Collegiate Athletic Association SA.
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Affiliation(s)
- Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI
| | - Allyssa K Memmini
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Traci R Snedden
- School of Nursing, University of Wisconsin-Madison, Madison, WI
| | | | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Darryl P Conway
- Department of Athletics, University of Michigan, Ann Arbor, MI
| | - Rushil Shah
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Christina L Master
- Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI
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11
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Cook NE, Kissinger-Knox A, Iverson IA, Liu BC, Gaudet CE, Norman MA, Iverson GL. Social Determinants of Health and Health Equity in the Diagnosis and Management of Pediatric Mild Traumatic Brain Injury: A Content Analysis of Research Underlying Clinical Guidelines. J Neurotrauma 2023; 40:1977-1989. [PMID: 37071186 PMCID: PMC10541940 DOI: 10.1089/neu.2023.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
We conducted a content analysis of the literature underlying the Centers for Disease Control and Prevention (CDC) Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children (i.e., the "Guideline") to determine the extent to which social determinants of health (SDoH) were examined or addressed. The systematic review forming the basis for the Guideline included 37 studies addressing diagnosis, prognosis, and treatment/rehabilitation. We examined those studies to identify SDoH domains derived from the U.S. Department of Health and Human Services' Healthy People 2020 and 2030 websites. No study explicitly mentioned "social determinants of health," by name, and few studies addressed SDoH domains as a primary focus (ranging from 0% to 27% of studies across SDoH domains). The most frequently represented SDoH domains, described in an inferential or a descriptive manner, were Education Access and Quality (29.7% of studies), Social and Community Context (27.0% of studies), and Economic Stability (21.6% of studies). Health Care Access (13.5% of studies) was less well represented and no studies (0%) examined Neighborhood and Built Environment. In terms of the CDC clinical questions, SDoH were only examined as predictors of outcome (prognosis) and no studies examined SDoH in relation to diagnosis or treatment/rehabilitation. The Guideline includes some commentary on health literacy and socioeconomic status. Overall, social determinants of health are largely unrepresented as important or meaningful variables influencing the Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children, or in the studies that informed the Guideline.
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Affiliation(s)
- Nathan E. Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Ila A. Iverson
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian C. Liu
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Charles E. Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Marc A. Norman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, California, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Shoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
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Beidler E, Kelshaw PM, Wallace J, Larson MJ, Munce TA, Donahue CC, Bowman TG, Pappadis MR, Decker MN, Walton SR, Didehbani N, Cifu DX, Resch JE. Racial identity and concussion diagnosis and recovery trajectories in collegiate athletes: a LIMBIC MATARS investigation. Brain Inj 2023:1-9. [PMID: 37691328 DOI: 10.1080/02699052.2023.2253528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To determine if there were concussion diagnosis and recovery disparities between collegiate athletes with Black and White racial identities. DESIGN Retrospective cohort study. METHODS Concussion information was extracted from NCAA athlete medical files at LIMBIC MATARS member institutions from the 2015-16' to 2019-20' academic years. A total of 410 concussions from 9 institutions were included that provided all independent (i.e. racial identity of Black or White) and dependent variable information (i.e. dates of injury, diagnosis, symptom resolution, and return to sport) that were analyzed using Mann-Whitney U tests. The sample consisted of 114 (27.8%) concussions sustained by Black athletes and 296 (72.1%) sustained by White athletes. RESULTS The overall sample had a median of 0 days between injury occurrence to diagnosis, 7 days to symptom resolution, and 12 days to return to sport. No significant timing differences were observed for concussion diagnosis (p = .14), symptom resolution (p = .39), or return to sport (p = 0.58) between collegiate athletes with Black versus White racial identities. CONCLUSIONS These findings may reflect equitable access to onsite sports medicine healthcare resources that facilitate concussion management in the collegiate sport setting. Future work should explore these associations with a larger and more diverse sample of collegiate athletes.
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Affiliation(s)
- Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - P M Kelshaw
- Department of Kinesiology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, New Hampshire, USA
| | - J Wallace
- Department of Health Science, Athletic Training Program, The University of Alabama, Tuscaloosa, Alabama, USA
| | - M J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - T A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - C C Donahue
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - T G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - M R Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - M N Decker
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - S R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - N Didehbani
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - D X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Martin EM, Byrd M, Amador A, Ridenhour E, Charalambous C. The Influence of Athletic Identity, Passion, and Perceptions of Severity of Concussions on Athletes' Willingness to Report Concussion Symptoms. J Sport Rehabil 2023; 32:757-763. [PMID: 37236616 DOI: 10.1123/jsr.2022-0246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/28/2023] [Accepted: 04/16/2023] [Indexed: 05/28/2023]
Abstract
CONTEXT The influence of several psychological characteristics on the willingness of athletes to report concussion behaviors has not been well explored. Therefore, the purpose of this study was to understand how athletic identity and sport passion predicted participants' willingness to report symptoms above what was explained by athlete demographics, concussion knowledge, and perceived seriousness of concussions. DESIGN The study was cross-sectional. METHODS Three-hundred and twenty-two male and female high school and club sport athletes completed survey measures of concussion knowledge, athletic identity, harmonious and obsessive passion, and degree to which athletes indicated they would report concussions and concussion symptoms. RESULTS Athletes scored moderately high on their knowledge of symptoms and other concussion information (mean = 16.21; ± = 2.88) and above the midpoint on their attitudes and behaviors toward reporting concussion symptoms (mean = 3.64; ± = 0.70). There were no differences between gender, t(299) = -.78, P = .44, and previous concussion education, t(296) = 1.93, P = .06, related to concussion knowledge. Results of a hierarchical regression indicated that after entering athlete demographics, concussion knowledge, and perceived seriousness of concussions, of the 3 psychological variables in the final stage of the model, only obsessive passion was a significant predictor of athlete's attitudes to report a concussion. CONCLUSIONS Perceived seriousness of concussion, perceived threat to long-term health, and obsessive passion were the strongest predictors of athlete's willingness to report concussions. Athletes who did not believe concussions posed a threat to their current or future health, and those that held an obsessive passion for sport were most at risk for not reporting concussions. Future research should continue to investigate the relationship between reporting behaviors and psychological factors.
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Affiliation(s)
| | - Megan Byrd
- Georgia Southern University, Statesboro, GA,USA
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Wingerson MJ, Magliato SN, Smulligan KL, Wilson JC, Little CC, Howell DR. Predicting Time to Evaluation After Pediatric Concussion: Factors Affecting Specialty Concussion Care. Orthop J Sports Med 2023; 11:23259671231186430. [PMID: 37655238 PMCID: PMC10467397 DOI: 10.1177/23259671231186430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 09/02/2023] Open
Abstract
Background The timing of clinical evaluation after pediatric concussion represents an important and potentially modifiable clinical milestone for diagnosis, selection of appropriate treatment pathways, and recovery prognosis. Patient demographics, socioeconomic status, or medical history may affect the time to the initial evaluation and subsequently influence recovery outcomes. Purpose/Hypothesis The purpose of this investigation was to evaluate the association of patient characteristics with the time to specialty evaluation after a concussion. It was hypothesized that patients with a history of concussion, a preexisting relationship with our specialty concussion program, or a higher ZIP code-based income estimate would present for care more quickly after a concussion than patients without these characteristics. Study Design Cross-sectional study; Level of evidence, 3. Methods Included were patients with a concussion between 6 and 18 years old who were seen for care at a single sports medicine center between January 1 and December 31, 2019. Patient demographic, socioeconomic, injury, and clinical characteristics were collected through a retrospective review of the medical records. The primary outcome was the number of days between the date of the concussion and the patient's initial specialty evaluation. Results Overall, 220 patients (mean age, 14.4 ± 2.5 years; 46% female) were seen for care at a mean of 9.7 ± 5.6 days (range, 1-21 days) after concussion. A shorter time to specialty evaluation was associated with a history of concussion (β = -1.72 [95% CI, -3.24 to -0.20]; P = .03) and a prior clinical relationship with the treating clinical department (β = -1.85 [95% CI, -3.52 to -0.19]; P = .03). Referral by a primary care provider was associated with a longer time to evaluation (β = 3.86 [95% CI, 2.39-5.33]; P < .0001). Conclusion A history of concussion and having a preexisting clinical relationship with the deparment were associated with a shorter time to evaluation after concussion. Referral from a primary care physician was associated with a longer time to evaluation. Issues may exist in the propensity to access care after an injury, resulting in delays for initiating early treatment.
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Affiliation(s)
- Mathew J. Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Samantha N. Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Katherine L. Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Julie C. Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Casey C. Little
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - David R. Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
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15
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Memmini AK, Mosesso KM, Perkins SM, Brett BL, Pasquina PF, McAllister TW, McCrea MA, Broglio SP. Premorbid Risk Factors and Acute Injury Characteristics of Sport-Related Concussion Across the National Collegiate Athletic Association: Findings from the Concussion Assessment, Research, and Education (CARE) Consortium. Sports Med 2023; 53:1457-1470. [PMID: 36929588 DOI: 10.1007/s40279-023-01830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Previous sport-related concussion research highlights post-injury characteristics that influence recovery trajectories; however, there is limited information regarding premorbid factors that affect sport-related concussion risk. OBJECTIVE We aimed to (a) compare premorbid demographic factors among a large cohort of collegiate student athletes who did or did not sustain a sport-related concussion and (b) assess differences in acute injury characteristics based on biological sex and contact level. METHODS We conducted a cohort study of university student athletes from 22 sports enrolled in the Concussion Assessment, Research, and Education (CARE) Consortium study from 2014 to 2021 (n = 1804 student athletes with sport-related concussions; n = 21,702 student athletes without sport-related concussions). RESULTS Statistical analyses indicated student athletes who self-identified as Black (odds ratio [OR] = 1.61; 95% confidence interval [CI] = 1.42, 1.81) or multiracial (OR = 1.32; 95% CI 1.10, 1.59) demonstrated greater odds of experiencing sport-related concussions than White-identifying student athletes. Additional findings suggest male athletes (OR = 1.47; 95% CI 1.20, 1.81) and contact sport student athletes (OR = 1.40; 95% CI 1.16, 1.70) may be at increased odds for sport-related concussions if they were previously diagnosed with attention deficit hyperactive disorder. Notable post-injury characteristics across sexes included differences in the incident loss of consciousness (male: 5.9%, female: 2.6%; p < 0.001), post-traumatic amnesia (male: 13.6%, female: 5.1%; p < 0.001), and retrograde amnesia (male: 6.8%, female: 2.8%; p < 0.001). A greater proportion of contact-sport student athletes experienced an altered mental status (52.7%) than limited contact (36.2%) and non-contact (48.6%) [p < 0.001]. Last, student athletes participating at lower contact levels were more likely to have a longer delay in removal from activity following injury (contact: 73.6 ± 322.2 min; limited contact: 139.1 ± 560.0 min; non-contact: 461.4 ± 1870.8 min; p = 0.005). CONCLUSIONS The present study provides contemporary pre- and post-sport-related concussion injury characteristics using a considerably sized cohort of collegiate student athletes. These findings support previous work suggesting sport-related concussion results in complex individualized clinical presentations, which may influence management strategies.
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Affiliation(s)
- Allyssa K Memmini
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, 87131-0001, USA.
- Concussion Center, University of Michigan, Ann Arbor, MI, USA.
| | - Kelly M Mosesso
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan M Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Cook NE, Gaudet CE, Kissinger-Knox A, Liu BC, Hunter AA, Norman MA, Saadi A, Iverson GL. Race, ethnicity, and clinical outcome following sport-related concussion: a systematic review. Front Neurol 2023; 14:1110539. [PMID: 37388549 PMCID: PMC10306165 DOI: 10.3389/fneur.2023.1110539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/10/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction This systematic review examined whether race or ethnicity are associated with clinical outcomes (e.g., time to return to school/sports, symptom duration, vestibular deficits, and neurocognitive functioning) following sport-related concussion among child, adolescent, or college-aged student athletes. Additionally, this review assessed whether the existing literature on this topic incorporated or included broader coverage of social determinants of health. Methods The online databases PubMed, MEDLINE®, PsycINFO®, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science were searched. Results A total of 5,118 abstracts were screened and 12 studies met inclusion criteria, including 2,887 youth and young adults. Among the included articles, only 3 studies (25%) examined whether race and ethnicity were associated with outcomes following concussion as a primary objective. None of the studies assessed the association between social determinants of health and outcomes following concussion as a primary objective, although 5 studies (41.7%) addressed a social determinant of health or closely related topic as a secondary objective. Discussion Overall, the literature to date is extremely limited and insufficient for drawing conclusions about whether race or ethnicity are categorically associated with outcomes from sport-related concussion, or more specifically, whether there are socioeconomic, structural, or cultural differences or disparities that might be associated with clinical outcome. Systematic review registration identifier: PROSPERO, CRD42016041479, CRD42019128300.
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Affiliation(s)
- Nathan E. Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Charles E. Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Brian C. Liu
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Amy A. Hunter
- Department of Public Health Sciences and Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States
- Injury Prevention Center, Connecticut Children's Medical Center and Hartford Hospital, Hartford, CT, United States
| | - Marc A. Norman
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
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Tang AR, Wallace J, Grusky AZ, Hou BQ, Hajdu KS, Bonfield CM, Zuckerman SL, Yengo-Kahn AM. Investigation of Factors Contributing to Racial Differences in Sport-Related Concussion Outcomes. World Neurosurg 2023; 173:e755-e765. [PMID: 36898629 DOI: 10.1016/j.wneu.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Following sport-related concussion (SRC), early studies have demonstrated racial differences in time to clinical recovery; however, these differences have not been fully explained. We sought to further explore these associations by considering possible mediating/moderating factors. METHODS Data from patients aged 12-18 years diagnosed with SRC from November 2017 to October 2020 were analyzed. Those missing key data, lost to follow-up, or missing race were excluded. The exposure of interest was race, dichotomized as Black/White. The primary outcome was time to clinical recovery (days from injury until the patient was either deemed recovered by an SRC provider or symptom score returned to baseline or zero.) RESULTS: A total of 389 (82%) White and 87 (18%) Black athletes with SRC were included. Black athletes more frequently reported no SRC history (83% vs. 67%, P = 0.006) and lower symptom burden at presentation (median total Post-Concussion Symptom Scale 11 vs. 23, P < 0.001) than White athletes. Black athletes achieved earlier clinical recovery (hazard ratio [HR] = 1.35, 95% CI 1.03-1.77, P = 0.030), which remained significant (HR = 1.32, 95% CI 1.002-1.73, P = 0.048) after adjusting for confounders associated with recovery but not race. A third model adding the initial Post-Concussion Symptom Scale score nullified the association between race/recovery (HR = 1.12, 95% CI 0.85-1.48, P = 0.410). Adding prior concussion history further reduced the association between race/recovery (HR = 1.01, 95% CI 0.77-1.34, P = 0.925). CONCLUSIONS Overall, Black athletes initially presented with fewer concussion symptoms than White athletes, despite no difference in time to clinic. Black athletes achieved earlier clinical recovery following SRC, a difference explained by differences in initial symptom burden and self-reported concussion history. These crucial differences may stem from cultural/psychologic/organic factors.
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Affiliation(s)
- Alan R Tang
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jessica Wallace
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, Alabama, USA
| | - Alan Z Grusky
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Brian Q Hou
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Christopher M Bonfield
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Mohammed FN, Master CL, Arbogast KB, McDonald CC, Sharma S, Kang B, Corwin DJ. Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population. J Head Trauma Rehabil 2023; 38:147-155. [PMID: 36731016 PMCID: PMC9998329 DOI: 10.1097/htr.0000000000000823] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the relationship of sociodemographic factors to adherence to provider recommendations for pediatric concussion. SETTING Primary care (PC) practices within the Children's Hospital of Philadelphia network. PARTICIPANTS Patients aged 5 to 18 years old who presented to any PC site for concussion from September 26, 2019, to December 31, 2019. DESIGN Retrospective medical record review. MAIN MEASURES The primary outcome was adherence to follow-up recommendations as defined by (1) continued follow-up until provider clearance to return to full activity; (2) no more than 2 no-show visits; and (3) for those referred to specialty care (SC), attending at least 1 visit. We compared adherence by race/ethnicity, insurance, age, sex, injury mechanism, and repeat head injury using bivariate and multivariate analyses. A secondary outcome of referral to SC was compared by sociodemographic factors. RESULTS A total of 755 patients were included. Overall, 80.5% of the patients met adherence criteria. Following adjustment, non-Hispanic Black patients and publicly insured/self-pay patients were less likely to adhere to recommendations than non-Hispanic White patients (adjusted odds ratio [AOR] = 0.60; 95% CI, 0.37-1.00) and privately insured patients (AOR = 0.48; 95% CI, 0.30-0.75), respectively. When assessing differences in referral to SC, non-Hispanic Black patients and publicly insured/self-pay patients were more likely to receive a referral than their non-Hispanic White peers (OR = 1.56; 95% CI, 1.00-2.45) and privately insured patients (OR = 1.56; 95% CI, 1.05-2.32), respectively. CONCLUSION This study highlights disparities in adherence to concussion care recommendations, with non-Hispanic Black and publicly insured/self-pay patients less likely to adhere to follow-up recommendations than non-Hispanic White and privately insured patients, respectively. These disparities may impact recovery trajectories. Future studies should aim to identify specific individual- and system-level barriers preventing adherence to care in order to ultimately inform targeted interventions to achieve equity in care delivery and outcomes.
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Affiliation(s)
- Fairuz N Mohammed
- Center for Injury Research and Prevention (Mrs Mohammed, Drs Master, Arbogast, McDonald, and Corwin, and Mss Sharma and Kang), Sports Medicine and Performance Center (Dr Master), and Division of Emergency Medicine (Drs Arbogast and Corwin), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine (Drs Master, Arbogast, McDonald, and Corwin) and School of Nursing (Dr McDonald), University of Pennsylvania, Philadelphia
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Rosenberg SI, Ouweleen AJ, Hall TB, Patel NM. Are Neighborhood Conditions Associated With Surgical Delays and Meniscus Tears in Children and Adolescents Undergoing ACL Reconstruction? Clin Orthop Relat Res 2023; 481:281-288. [PMID: 36103207 PMCID: PMC9831176 DOI: 10.1097/corr.0000000000002368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Markers of a patient's social determinants of health, including healthcare insurance and median household income based on ZIP Code, have been associated with the interval between injury and ACL reconstruction (ACLR) as well as the presence of concomitant meniscus tears in children and adolescents. However, the aforementioned surrogate indicators of a patient's social determinants of health may not reflect all socioeconomic and healthcare resources affecting the care of ACL injuries in children and adolescents. The use of multivariate indices such as the Child Opportunity Index (COI) may help to better identify patients at risk for increased risk for delay between ACL injury and surgery, as well as the incidence of meniscus tears at the time of surgery. The COI is a summative measure of 29 indicators that reflect neighborhood opportunities across three domains: education, health and environment, and social and economic factors. COI scores range from 0 to 100 (100 being the highest possible score), as well as five categorical scores (very low, low, moderate, high, and very high) based on quintile rankings. QUESTIONS/PURPOSES To investigate the relationship between neighborhood conditions and the treatment of ACL injuries in children and adolescents via the COI, we asked: (1) Is a lower COI score associated with a longer delay between ACL injury and surgery? (2) Does a higher proportion of patients with lower COI scores have meniscus tears at the time of ACLR? METHODS In this retrospective, comparative study, we considered data from 565 patients, 18 years or younger, who underwent primary ACLR at an urban, tertiary children's hospital between 2011 and 2021. Of these patients, 5% (31 of 565) did not have a clearly documented date of injury, 2% (11 of 565) underwent revision reconstructions, and 1% (5 of 565) underwent intentionally delayed or staged procedures. Because we specifically sought to compare patients who had low or very low COI scores (lowest two quintiles) with those who had high or very high scores (highest two quintiles), we excluded 18% (103 of 565) of patients with moderate scores. Ultimately, 73% (415 of 565) of patients with COI scores in either the top or bottom two quintiles were included. Patient addresses at the time of surgery were used to determine the COI score. There were no differences between the groups in terms of gender. However, patients with high or very high COI scores had a lower median (IQR) age (15 years [2.6] versus 17 years [1.8]; p < 0.001) and BMI (23 kg/m 2 [6.1] versus 25 kg/m 2 [8.8]; p < 0.001), were more commonly privately insured (62% [117 of 188] versus 22% [51 of 227]; p < 0.001), and had a higher proportion of patients identifying as White (67% [126 of 188] versus 6.2% [14 of 227]; p < 0.001) compared with patients with low or very low COI scores. Medical records were reviewed for demographic, preoperative, and intraoperative data. Univariate analyses focused on the relationship of the COI and interval between injury and surgery, frequency of concomitant meniscus tears, and frequency of irreparable meniscus tears treated with partial meniscectomy. Multivariable regression analyses were used to determine factors that were independently associated with delayed surgery (longer than 60 and 90 days after injury), presence of concomitant meniscal injuries, and performance of meniscectomy. Multivariable models included insurance and race or ethnicity to determine whether COI was independently associative after accounting for these variables. RESULTS Patients with a high or very high COI score had surgery earlier than those with a low or very low COI score (median [IQR] 53 days [53] versus 97 days [104]; p < 0.001). After adjusting for insurance and race/ethnicity, we found that patients with a low or very low COI score were more likely than patients with a high or very high COI score to have surgery more than 60 days after injury (OR 2.1 [95% CI 1.1 to 4.0]; p = 0.02) or more than 90 days after injury (OR 1.8 [95% CI 1.1 to 3.4]; p = 0.04). Furthermore, patients with low or very low COI scores were more likely to have concomitant meniscus tears (OR 1.6 [95% CI 1.1 to 2.5]; p = 0.04) compared with patients with high or very high COI scores. After controlling for insurance, race/ethnicity, time to surgery, and other variables, there was no association between COI and meniscectomy (OR 1.6 [95% CI 0.9 to 2.8]; p = 0.12) or presence of a chondral injury (OR 1.7 [95% CI 0.7 to 3.9]; p = 0.20). CONCLUSION As the COI score is independently associated with a delay between ACL injury and surgery as well as the incidence of meniscus tears at the time of surgery, this score can be useful in identifying patients and communities at risk for disparate care after ACL injury. The COI score or similar metrics can be incorporated into medical records to identify at-risk patients and dedicate appropriate resources for efficient care. Additionally, neighborhoods with a low COI score may benefit from improvements in the availability of additional and/or improved resources. Future studies should focus on the relationship between the COI score and long-term patient-reported functional outcomes after ACL injury, identification of the specific timepoints in care that lead to delayed surgery for those with lower COI scores, and the impact of community-based interventions in improving health equity in children with ACL injury. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | - Tyler B. Hall
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neeraj M. Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Orthopaedic Surgery and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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20
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Sarmiento K, Miller GF, Jones SE. Sports-Related Concussions and Adverse Health Behaviors Among Middle and High School Students. Am J Sports Med 2023; 51:503-510. [PMID: 36637145 PMCID: PMC9932634 DOI: 10.1177/03635465221141440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Concussions affect millions of youths in the United States each year, and there is concern about long-term health effects from this injury. PURPOSE To examine the association between sports- or physical activity-related concussion and health risk behaviors among middle and high school students in 9 states. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Data from the 2019 middle school and high school Youth Risk Behavior Survey were used for this analysis. Nine states were identified that included the same question on concussion and similar questions on health risk behaviors in their 2019 Youth Risk Behavior Survey. Students were asked to self-report whether they had ≥1 sports- or physical activity-related concussions during the 12 months preceding the survey. Self-reported concussion was the primary outcome of interest. Other variables included sex, race/ethnicity, played on a sports team, were physically active 5 or more days/week, ever tried cigarette smoking, ever used an electronic vapor product, academic grades, drank alcohol, were in a physical fight, seriously considered attempting suicide, made a suicide plan, and attempted suicide. RESULTS Among the 9 states, 18.2% of middle school students and 14.3% of high school students self-reported ≥1 sports- or physical activity-related concussions. Among both middle school and high school students, the prevalence of ≥1 sports- or physical activity-related concussions was higher among students who played on a sports team, were physically active 5 or more days per week, had ever tried cigarette smoking, had ever used an electronic vapor product, had seriously considered attempting suicide, had made a suicide plan, and had attempted suicide compared with those who had not engaged in those behaviors. The prevalence of sports- or physical activity-related concussion was consistently higher among middle school students than high school students across sex, race/ethnicity, and adverse health behaviors. CONCLUSION Middle school students with a history of concussion warrant attention as an at-risk population for concussions and adverse health behaviors. Health care providers may consider screening students for adverse health behaviors during preparticipation examinations and concussion evaluations.
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Affiliation(s)
- Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gabrielle F. Miller
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Bullock GS, Mobley JF, Brooks JM, Rauh MJ, Gil Gilliland R, Kissenberth MJ, Shanley E. Uses of Health Care System Medical Care Services by Athletes After Injury at the High School Level. THE JOURNAL OF SCHOOL HEALTH 2023; 93:5-13. [PMID: 36263850 PMCID: PMC10091823 DOI: 10.1111/josh.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Health care utilization can vary by age group, geographic location, and socioeconomic status (SES). A paucity of information exists regarding the availability and utilization of medical care by injured scholastic athletes. The purpose of this study was to describe and compare injuries and health care service utilization by school SES over an academic year. METHODS Injury and health care service data was collected from 1 large school district. Percentage of free and reduced lunch (FRPL) for each school was calculated to stratify schools into high (<50% FRPL) and low (≥50.1% FRPL) SES groups. Incidence proportion and relative risk (RR) with 95% confidence intervals (95% CI) were calculated. RESULTS About 1756 injuries were reported among over 7000 participating athletes from 14 high schools. Similar injury incidence proportions were reported between high and low SES schools (RR = 1.10 [1.00-1.20]). Athletes from low SES schools were twice (RR = 2.01 [1.21-3.35]) and over three (RR = 3.42 [1.84-6.55]) times more likely to receive emergency and physical therapy care. SES was not associated with the use of physician, imaging, or surgery services. IMPLICATIONS FOR SCHOOL HEALTH, POLICY, AND EQUITY School medical providers and administrators should have ready and provide a list of trusted outside primary care and specialty providers that have experience in sports medicine. They should also enquire and follow up on which outside provider the high school athlete will seek care when referring out to outside providers. CONCLUSIONS Injury incidence was similar between high and low SES schools. However, athletes from low SES high schools were over 2-fold more likely to use emergency department services. Understanding factors influencing health care services choice and usage by student athletes from different socioeconomic backgrounds may assist sport medicine clinicians in identifying barriers and potential solutions in improving time to health restoration, athlete outcomes, and health care monetary burden.
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Affiliation(s)
- Garrett S. Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest School of Medicine, Winston‐Salem, NC; Centre for Sport, Exercise and Osteoarthritis Research Versus ArthritisUniversity of OxfordOxfordUK
| | - John F. Mobley
- University of South Carolina School of MedicineColumbiaSC
| | - John M. Brooks
- South Carolina Center for Effectiveness Research in OrthopaedicsUniversity of South CarolinaColumbiaSC
| | - Mitchel J. Rauh
- College of Health and Human ServicesSand Diego State UniversitySan DiegoCA
| | | | | | - Ellen Shanley
- University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, SC; ATI Physical TherapyGreenvilleSC
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22
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Hudac CM, Wallace JS, Ward VR, Friedman NR, Delfin D, Newman SD. Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods. Front Neurol 2022; 13:918075. [PMID: 36619932 PMCID: PMC9812645 DOI: 10.3389/fneur.2022.918075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Concussive events and other brain injuries are known to reduce cognitive inhibition, a key aspect of cognition that supports ones' behaviors and impacts regulation of mood or affect. Our primary objective is to investigate how induction of negative affect (such as frustration) impacts cognitive inhibition and the dynamic process by which youth athletes modulate responses. Secondary objective is to address the lack of Black representation in the scientific literature that promotes brain health and investigates pediatric sports-related brain injury. In particular, neuroscience studies predominantly include White participants despite broad racial representation in sport, in part due to technological hurdles and other obstacles that challenge research access for Black participants. Methods Using electroencephalography (EEG), we evaluate the dynamic brain processes associated with cognitive inhibition in the context of frustration induction in adolescent athletes during pre-season conditioning (i.e., prior to contact; N = 23) and a subset during post-season (n = 17). Results The N2 component was sensitive to frustration induction (decreased N2 amplitude, slower N2 latency), although effects were less robust at postseason. Trial-by-trial changes indicated a steady decrease of the N2 amplitude during the frustration block during the preseason visit, suggesting that affective interference had a dynamic effect on cognitive inhibition. Lastly, exploratory analyses provide preliminary evidence that frustration induction was less effective for athletes with a previous history of concussion or migraines (trending result) yet more effective for athletes endorsing a history with mental health disorders. Discussion We emphasize the urgent need to improve representation in cognitive neuroscience, particularly as it pertains to brain health. Importantly, we provide detailed guides to our methodological framework and practical suggestions to improve representative participation in studies utilizing high-density mobile EEG.
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Affiliation(s)
- Caitlin M. Hudac
- Department of Psychology, University of South Carolina, Columbia, SC, United States,Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, United States,Department of Psychology, University of Alabama, Tuscaloosa, AL, United States,Center for Autism and Neurodevelopment Research Center, University of South Carolina, Columbia, SC, United States,*Correspondence: Caitlin M. Hudac
| | - Jessica S. Wallace
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, AL, United States
| | - Victoria R. Ward
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, United States,Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
| | - Nicole R. Friedman
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, United States,Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
| | - Danae Delfin
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, AL, United States
| | - Sharlene D. Newman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States,Alabama Life Research Institute, University of Alabama, Tuscaloosa, AL, United States
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23
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Patel NM, Edison BR, Carter CW, Pandya NK. The Impact of Race, Insurance, and Socioeconomic Factors on Pediatric Knee Injuries. Clin Sports Med 2022; 41:789-798. [DOI: 10.1016/j.csm.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Beran KM, Scafide KN. Factors Related to Concussion Knowledge, Attitudes, and Reporting Behaviors in US High School Athletes: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:406-417. [PMID: 35075658 DOI: 10.1111/josh.13140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sport-related concussions are a major public health problem with only 50% of concussed teens reporting their symptoms. The purpose of this systematic review was to identify individual and institutional factors that contribute to concussion knowledge, attitude, and reporting behaviors among US high school athletes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol was used to direct the process of this systematic review. A search for English, peer-reviewed, quantitative studies published between 2010 and 2020 was conducted in 5 scholarly databases. The Joanna Briggs Critical Appraisal Tools were used to assess study quality. RESULTS Twenty-two studies met criteria for inclusion in this systematic review. The study designs were mostly cross-sectional (N = 18). Synthesis revealed individual factors including gender, age, race/ethnicity, grade level, and concussion history were associated with differences in concussion knowledge, attitude, and/or reporting behaviors. Institutional factors identified included school location, concussion education, access to an athletic trainer, sport played, and team climate. Six studies found concussion education had a positive impact on knowledge and reporting behaviors. CONCLUSION This systematic review identified certain populations which may be more vulnerable to underreporting concussion symptoms; therefore, a targeted approach to education and management may be more effective.
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Affiliation(s)
- Krista M Beran
- Doctoral Candidate, , College of Health and Human Services, George Mason University, 4400 University Dr., Fairfax, VA 22030
| | - Katherine N Scafide
- Associate Professor, , College of Health and Human Services, George Mason University, 4400 University Dr., Fairfax, VA 22030
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25
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Miller GF, Sarmiento K, Haarbauer-Krupa J, Jones SE. The Association Between School District-Based Policies Related to Concussions and Concussions Among High School Students. THE JOURNAL OF SCHOOL HEALTH 2022; 92:140-147. [PMID: 34806180 PMCID: PMC8792342 DOI: 10.1111/josh.13113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/05/2021] [Accepted: 05/20/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Little is known about the effectiveness of school district concussion policies on reducing the concussion prevalence among students. METHODS Data from the 2016 School Health Policies and Practices Study and 2017 Youth Risk Behavior Survey for 10 school districts were linked. The outcome variable was having a sports- or physical activity-related concussion during the 12 months before of the survey. Exposure variables were 2 district policies, including district-funded professional development and prioritizing return to the classroom before returning to athletics. Logistic regression models estimated the odds of a concussion among students in districts with one, both, or neither policy (referent). RESULTS In districts with district-funded professional development, the odds of students self-reporting ≥2 sports- or physical activity-related concussions were 1.4 times higher than in districts with neither policy. In districts with a policy prioritizing a return to the classroom before returning to athletics, the odds of students self-reporting ≥2 concussions were significantly lower (OR = 0.6) than in districts with neither policy. CONCLUSION School district concussion policies may have positive effects by identifying and reducing multiple concussions among students.
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Affiliation(s)
- Gabrielle F. Miller
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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26
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Yeates TM, Taylor HG, Bigler ED, Minich NM, Tang K, Cohen DM, Bacevice A, Mihalov LK, Bangert B, Zumberge NA, Yeates KO. Sex Differences in the Outcomes of Mild Traumatic Brain Injury in Children Presenting to the Emergency Department. J Neurotrauma 2022; 39:93-101. [PMID: 33678004 PMCID: PMC8785718 DOI: 10.1089/neu.2020.7470] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Sex differences after concussion have been studied largely in high school and college athletes, often without reference to comparison groups without concussion. This study sought to evaluate sex differences in outcomes among all children and adolescents presenting to the Emergency Department (ED) for either mild traumatic brain injury (TBI) or orthopedic injury (OI), regardless of mechanism of injury. The study involved a concurrent cohort, prospective study design with longitudinal follow-up. Participants were eight to 16 years old with mild TBI (n = 143) or OI (n = 73). They were recruited and completed an initial assessment at EDs at two children's hospitals. They returned for a post-acute assessment within two weeks of injury and for follow-up assessments at three and six months. Outcomes included child and parent proxy ratings of somatic and cognitive symptoms, and standardized tests of cognitive functioning and balance. Sex did not moderate group differences in balance, fluid or crystallized cognitive ability, or child or parent proxy ratings of somatic or cognitive symptoms. Both parents and children reported more somatic symptoms in girls than boys, but in both groups. Compared with the OI group, the mild TBI group showed significantly lower fluid cognitive ability at the post-acute assessment and significantly higher somatic and cognitive symptoms according to both child and parent proxy ratings across the first two weeks post-injury. The results suggest that sex does not moderate the outcomes of mild TBI in a pediatric ED population. Previous research pointing to sex differences after concussion may reflect the lack of comparison groups, as well as a focus on adolescents and young adults and sport-related concussion. Future research should investigate whether sex moderates the outcomes of pediatric mild TBI in adolescents but not in pre-adolescent children.
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Affiliation(s)
- Taylor M. Yeates
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA.,Address correspondence to: Taylor M. Yeates, MPH, Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, 3640 Colonel Glenn Hwy, Fairborn, OH 45324, USA
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Erin D. Bigler
- Deparment of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Nori M. Minich
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Ken Tang
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Daniel M. Cohen
- Abigail Wexner Research Institute at Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Leslie K. Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Barbara Bangert
- Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio, USA
| | | | - Keith Owen Yeates
- Departments of Psychology, Pediatrics, and Clinical Neurosciences, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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27
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Wallace J, Beidler E, Register-Mihalik JK, Hibbler T, Bretzin A, DeMedal S, Kerr ZY. Examining Concussion Nondisclosure in Collegiate Athletes Using a Health Disparities Framework and Consideration of Social Determinants of Health. J Athl Train 2022; 57:16-24. [PMID: 35040984 PMCID: PMC8775278 DOI: 10.4085/1062-6050-0054.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Limited research exists concerning the relationship between the social determinants of health (SDOHs), including race, socioeconomic status (SES), health care access and physical environment and concussion nondisclosure in collegiate athletes. However, among high school athletes, disparities have been noted, with Black athletes who attended under-resourced schools and lacked access to an athletic trainer (AT) disclosing fewer concussions. OBJECTIVE To investigate whether concussion nondisclosure disparities existed by (1) race, (2) SES, or (3) AT health care access before college and understand the differential reasons for concussion nondisclosure between White and Black collegiate athletes. DESIGN Cross-sectional study. SETTING Collegiate athletics. PARTICIPANTS A total of 735 college athletes (84.6% White, 15.4% Black). MAIN OUTCOME MEASURE(S) Participants completed a questionnaire that directly assessed concussion nondisclosure, including reasons for not reporting a suspected concussion. With the premise of investigating SDOHs, race was the primary exposure of interest. The outcome of interest, nondisclosure, was assessed with a binary (yes or no) question, "Have you ever sustained a concussion that you did not report to your coach, AT, parent, teammate, or anyone else?" RESULTS Among the White and Black athletes, 15.6% and 17.7%, respectively, reported a history of concussion nondisclosure. No differences were found by race for distributions of history of concussion nondisclosure (P = .57). Race was not associated with concussion nondisclosure when evaluated as an effect modification measure or confounder, and no significant associations were noted by SES or high school AT access. Differences by race for reported reasons for nondisclosure were present for "At the time, I did not think it was a concussion" (P = .045) and "I thought my teammates would think I am weak" (P = .03), with Black athletes selecting these more frequently than White athletes. CONCLUSIONS These data help to contextualize race and its intersection with other SDOHs that could influence concussion nondisclosure outcomes in collegiate athletes.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, Athletic Training Program, The University of Alabama, Tuscaloosa
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, PA
| | | | - Tamaria Hibbler
- Department of Athletics, Michigan State University, East Lansing
| | | | - Spencer DeMedal
- Department of Biological Sciences, Duquesne University, Pittsburgh, PA
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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28
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Lempke LB, Kerr ZY, Melvin P, Walton SR, Wallace JS, Mannix RC, Meehan WP, Ward VL. Examining racial and ethnic disparities in adult emergency department patient visits for concussion in the United States. Front Neurol 2022; 13:988088. [PMID: 36247794 PMCID: PMC9563304 DOI: 10.3389/fneur.2022.988088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background Racial and ethnic differences in emergency department (ED) visits have been reported among adolescent patients but are unsubstantiated among adults. Therefore, our purpose in this study was to examine the relationship between race/ethnicity and adult ED visits for concussions, their injury mechanisms, and computed tomography (CT) scan use among a nationally representative sample. Methods We used the National Hospital Ambulatory Medical Care Survey database from 2010-2015 to examine 63,725 adult (20-45 years old) patient visits, representing an estimated 310.6 million visits presented to EDs. Of these visits, 884 (4.5 million national estimate) were diagnosed with a concussion. Visit records detailed patient information (age, sex, race/ethnicity, geographic region, primary payment type), ED visit diagnoses, injury mechanism (sport, motor vehicle, fall, struck by or against, "other"), and head CT scan use. The primary independent variable was race/ethnicity (non-Hispanic Asian, non-Hispanic Black or African American, Hispanic/Latinx, non-Hispanic multiracial or another, and non-Hispanic White). We used multivariable logistic and multinomial regression models with complex survey sampling design weighting to examine the relationship between concussion ED visits, injury mechanisms, and CT scan use separately by race/ethnicity while accounting for covariates. Results There were no associations between race/ethnicity and concussion diagnosis among adult ED visits after accounting for covariates. Relative to sports-related injuries, non-Hispanic Black or African American patient visits were associated with a motor vehicle (OR = 2.69, 95% CI: 1.06-6.86) and "other" injury mechanism (OR = 4.58, 95% CI: 1.34-15.69) compared to non-Hispanic White patients. Relative to sports-related injuries, non-Hispanic Asian, multiracial, or patients of another race had decreased odds of falls (OR = 0.20, 95% CI: 0.04-0.91) and "other" injuries (OR = 0.09, 95% CI: 0.01-0.55) compared to non-Hispanic White patients. The odds of a CT scan being performed were significantly lower among Hispanic/Latinx patient visits relative to non-Hispanic White patients (OR = 0.52, 95% CI: 0.30-0.91), while no other race/ethnicity comparisons differed. Conclusion Our findings indicate that the overarching concussion ED visit likelihood may not differ by race/ethnicity in adults, but the underlying mechanism causing the concussion and receiving a CT scan demonstrates considerable differences. Prospective future research is warranted to comprehensively understand and intervene in the complex, multi-level race/ethnicity relationships related to concussion health care to ensure equitable patient treatment.
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Affiliation(s)
- Landon B Lempke
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States.,Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrice Melvin
- Office of Health Equity and Inclusion, The Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States
| | - Samuel R Walton
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica S Wallace
- Department of Health Science, University of Alabama, Tuscaloosa, AL, United States
| | - Rebekah C Mannix
- Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
| | - William P Meehan
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States.,Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Valerie L Ward
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States.,Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States.,Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States.,Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States
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Yengo-Kahn AM, Wallace J, Jimenez V, Totten DJ, Bonfield CM, Zuckerman SL. Exploring the outcomes and experiences of Black and White athletes following a sport-related concussion: a retrospective cohort study. J Neurosurg Pediatr 2021; 28:516-525. [PMID: 34428742 DOI: 10.3171/2021.2.peds2130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Young American athletes, at risk of sport-related concussion (SRC), represent many races; however, it is unknown how race may influence the experience and outcome of SRC. The authors' objective was to compare White and Black athletes' recovery and subjective experiences after SRC. METHODS A retrospective study was performed using the Vanderbilt Sports Concussion registry. Self-reported White and Black young athletes (ages 12-23 years) who had been treated for SRC between 2012 and 2015 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data were collected by electronic medical record review and phone calls to athletes and parents or guardians. The primary outcomes were as follows: 1) days to symptom resolution (SR), 2) days to return to school, and changes in 3) any daily activity (binary) and 4) sport behavior (binary). Secondary outcomes were changes (more, unchanged, or less) in specific activities such as sleep, schoolwork, and television time, as well as equipment (binary) or playing style (more reckless, unchanged, or less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards models, and logistic regression were performed. RESULTS The final cohort included 247 student-athletes (36 Black, 211 White). Black athletes were male (78% vs 58%) more often than White athletes, but both races were similar in age, sport, and medical/family histories. Black athletes more frequently had public insurance (33.3% vs 5.7%) and lived in areas with a low median income (41.2% vs 26.6%). After adjusting for age, sex, concussion history, insurance status, and zip code median income, Black athletes reached an asymptomatic status (HR 1.497, 95% CI 1.014-2.209, p = 0.042) and returned to school earlier (HR 1.522, 95% CI 1.020-2.270, p = 0.040). Black athletes were less likely to report a change in any daily activity than White athletes (OR 0.368, 95% CI 0.136-0.996, p = 0.049). Changes in sport behavior were comparable between the groups. CONCLUSIONS Racial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached SR and return to school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.
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Affiliation(s)
- Aaron M Yengo-Kahn
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
- 2Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica Wallace
- 3Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, Alabama
| | - Viviana Jimenez
- 2Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
- 4Department of Neurology, Vanderbilt University Medical Center; and
| | - Douglas J Totten
- 2Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
- 5Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Christopher M Bonfield
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
- 2Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
- 2Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
Purpose of Review Youth sports participation has shifted from a school-based, seasonal activity to club-based, year-round activity over the past 10–15 years. Single sport specialization has become increasingly common with a concurrent increase in injury and burnout. Paralleling trends seen in other aspects of health care, disparities in regard to participation in youth sports, and subsequent injury treatment exist as well. Recognition of these disparities amongst coaches, parents, and athletes involved in youth sports are essential to promote the short- and long-term health of pediatric and adolescent athletes. Recent Findings Multiple barriers exist for youth in regard to sports participation. Youth who come from families without extensive financial means are increasingly finding it difficult to play organized sports, with this trend holding when broken down by insurance status (public versus private). This problem is further exacerbated by the lack of community-based programming in locations where organized (albeit expensive) options do not exist. The lack of athletic trainers increases the divide, as well as the care that injured athletes receive (particularly in public schools within communities of color) is not equivalent to schools with extensive financial resources. Thus, ability to quickly return to play after injury and/or access the health care system is limited. This is further exemplified by inferior outcomes in regard to care for anterior cruciate ligament, meniscus, shoulder instability, and concussions in this population. Summary Youth sports participation is laden with multiple disparities. This is unfortunately reflective of historical barriers to opportunities/advancements in multiple other areas of society. These disparities place certain groups of children at an uphill battle not only for participation when healthy, but also returning to participation when injured. Larger structural changes in youth sports are necessary to promote life-long, healthy physical activities for individuals most at risk.
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Affiliation(s)
- Nirav Kiritkumar Pandya
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA. .,Department of Pediatric Orthopedic Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA.
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Wallace J, Hou BQ, Hajdu K, Tang AR, Grusky AZ, Lee T, Zuckerman SL, Yengo-Kahn AM. Healthcare Navigation of Black and White Adolescents Following Sport-Related Concussion: A Path Towards Achieving Health Equity. J Athl Train 2021; 57:352-359. [PMID: 35439315 PMCID: PMC9020596 DOI: 10.4085/1062-6050-0330.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. These differences may not only stem from health inequities but can further perpetuate disparities in care for SRCs. OBJECTIVE To determine whether racial differences exist in the care pathway from injury to SRC clinic within adolescent athletes. DESIGN Retrospective cohort Setting: Regional SRC center Participants: Of 582 total athletes, 486 (83.5%) White and 96 (16.5%) Black adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic. MAIN OUTCOME MEASURES Race was the defined exposure, dichotomized as Black or White. The four primary outcomes included: 1)location of first health system contact, 2)time from injury to first health system contact 3) time to in-person SRC clinic visit, and 4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or lost to follow-up. RESULTS Black and White athletes mostly presented directly to SRC clinic (61.5% vs 62.3%) at a median[interquartile range] of 3[1,5] vs 4[1,8] days respectively (p=0.821). Similar proportions of Black and White athletes also first presented to the ED (30.2% vs 27.2%) at a median of 0[0,1] vs 0[0,1] days (p=0.941). Black athletes more frequently had care transferred to their athletic trainer (39.6% vs 29.6%) and less frequently established care (56.3% vs 64.0%), however these differences were not statistically significant (p=0.138). Lost to follow-up was uncommon among Black and White athletes alike (4.2% vs 6.4%). CONCLUSIONS This study demonstrated that within an established SRC referral network and multidisciplinary clinic, there were no observed racial disparities in how athletes were initially managed and/or ultimately presented to SRC clinic despite racial differences in school type and insurance coverage. SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.
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Affiliation(s)
- Jessica Wallace
- 1Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, AL
| | - Brian Q Hou
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine Hajdu
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Alan R Tang
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Z Grusky
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Timothy Lee
- 3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- 3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN.,4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Aaron M Yengo-Kahn
- 3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN.,4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
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Kuhn AW, Grusky AZ, Cash CR, Churchwell AL, Diamond AB. Disparities and Inequities in Youth Sports. Curr Sports Med Rep 2021; 20:494-498. [PMID: 34524194 DOI: 10.1249/jsr.0000000000000881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Participation in youth sports can have a positive, lasting impact on a child's general health and physical well-being. Unfortunately, some youth populations are unable to participate and/or reap the benefits of sports because of existing inequities. Youth from lower socioeconomic status and ethnic minority children have been found to participate in sports less. These disparities are unfortunately pervasive and likely the result of multiple barriers, including financial and time constraints, limited resources and the inability to access facilities both in and out of school, and lack of familial support. There also exist inequities with regard to sports injury management, including knowledge, access to athletic trainers, and care. This article provides a review of the numerous disparities and inequities in youth sports. Compiling and understanding these data may help develop a framework to make youth sports more equitable and beneficial for all.
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Affiliation(s)
- Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Alan Z Grusky
- Vanderbilt University School of Medicine, Nashville, TN
| | - Carsen R Cash
- Vanderbilt University School of Medicine, Nashville, TN
| | | | - Alex B Diamond
- Department of Orthopaedic Surgery and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Wallace J, Bretzin A, Beidler E, Hibbler T, Delfin D, Gray H, Covassin T. The Underreporting of Concussion: Differences Between Black and White High School Athletes Likely Stemming from Inequities. J Racial Ethn Health Disparities 2021; 8:1079-1088. [PMID: 32926391 DOI: 10.1007/s40615-020-00864-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Previous studies have found that Black high school athletes have poorer knowledge about concussions and have fewer sports medicine healthcare resources than White athletes, but research on concussion disclosure by race is still needed. Therefore, the purpose of this study was to examine racial differences in concussion reporting behaviors between Black and White high school athletes. This cross-sectional study administered surveys to 577 high school athletes (64.5% Black; 72.3% males; 16.02 ± 1.2 years) from 14 schools (title I, n = 9; non-title I, n = 5). The survey included self-reported items on concussions and bell-ringers experienced during games and practices and the number of these episodes that were reported to an authoritative figure. Reasons for reporting and not reporting were also assessed. Results found that White athletes were more likely to recall experiencing a bell-ringer in games compared with Black athletes. They were also more likely to report a bell-ringer or concussion that occurred in a game. There was a significantly higher proportion of Black athletes compared with White athletes that did not report their bell-ringer experienced in games and concussions experienced in practices. White athletes were more likely than Black athletes to disclose a concussion because they thought they had a concussion, while there were no racial differences in the reasons for not reporting. The findings of this study highlight the critical role that race, as a social determinant of health, may play in concussion reporting in high school athletes. Future public health efforts should seek to further understand and overcome inequities in healthcare resources for concussion education and management.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL, 35487, USA.
| | - Abigail Bretzin
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Blockley Hall Room 937, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, 600 Forbes Avenue, 118 Health Sciences Building, Pittsburgh, PA, 15282, USA
| | - Tamaria Hibbler
- Department of Kinesiology, Athletic Training, Michigan State University, East Lansing, MI, 48840, USA
| | - Danae Delfin
- Department of Health Science, University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL, 35487, USA
| | - Haleigh Gray
- Department of Health Science, University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL, 35487, USA
| | - Tracey Covassin
- Department of Kinesiology, Athletic Training, Michigan State University, East Lansing, MI, 48840, USA
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Wallace JS, Mannix RC. Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency Department. J Pediatr 2021; 233:249-254.e1. [PMID: 33524386 DOI: 10.1016/j.jpeds.2021.01.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To 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). STUDY DESIGN A retrospective, cross-sectional study of patient (age ≤19 years) visits to the ED for concussion between 2010-2015, using the National Hospital Ambulatory Medical Care Survey, was completed. The primary study exposure was race/ethnicity. Outcome measures included ED visits that resulted in a concussion/MHT diagnosis and mechanism of injury. Mechanism categories included sport, motor vehicle collision, fall, assault, and other mechanism. A multivariable logistic regression and multinomial logistic regression were conducted to assess relationships between race/ethnicity and outcomes. Findings were weighted to reflect population estimates. RESULTS In total, 1263 child/adolescent visits for concussion/MHT were identified, representing an estimated 6.6 million child/adolescent visits nationwide. Compared with non-Hispanic White pediatric patients, non-Hispanic Black patients were least likely to have an ED visit for a concussion/MHT (P < .001; OR, 0.66; 95% CI, 0.52-0.83) The odds of non-Hispanic Black children/adolescents (OR, 3.80; 95% CI, 1.68-8.55) and children/adolescents of other race/ethnicity (OR, 4.93; 95% CI, 1.09-22.23) sustaining a concussion/MHT resulting from assault vs sport was higher. CONCLUSIONS Amid the emerging focus on sport-related concussion, these ethnic/racial differences in ED diagnosis of concussion/MHT demonstrate sociodemographic differences that warrant further attention. Assault may be a more common mechanism of concussion among children/adolescents of a racial minority.
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Affiliation(s)
- Jessica S Wallace
- Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA; Department of Health Science, University of Alabama, Tuscaloosa, AL.
| | - Rebekah C Mannix
- Departments of Pediatrics & Emergency Medicine, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
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Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-Athletes. J Head Trauma Rehabil 2021; 36:139-148. [PMID: 33938514 DOI: 10.1097/htr.0000000000000672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Basic concussion symptom knowledge is fundamental to concussion identification; however, racial disparities in concussion knowledge exist in high school and youth sports. It is unknown whether similar differences exist in collegiate-athletes. Identifying racial disparities in concussion knowledge and sources of concussion information is essential to inform equitable approaches to knowledge translation and educational interventions. This study examined how Black and White collegiate-athletes differed in their knowledge of concussion symptoms and use of concussion information sources. SETTING National Collegiate Athletic Association (NCAA) institutions. PARTICIPANTS Collegiate-athletes. DESIGN Cross-sectional. MAIN MEASURES Collegiate-athletes completed a questionnaire that assessed personal and sports demographics, concussion symptom knowledge, and use of concussion information sources. Fisher's exact tests and Wilcoxon rank-sum tests examined differences in outcome measures between Black and White collegiate-athletes. A multivariable Poisson regression model examined the association between race and concussion symptom knowledge scores while accounting for sex, sports contact level, NCAA division, concussion history, and specific concussion information sources. Incidence rate ratios (IRRs) with 95% CIs excluding 1.00 were deemed significant. RESULTS A total of 768 (82.6% White, 17.4% Black) collegiate-athletes completed the questionnaire. Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes (P < .001). In the multivariable Poisson regression model controlling for covariates, this finding was retained (IRR = 0.97; 95% CI, 0.94-0.997). White athletes were more likely to report school-based professional (P < .001), online medical sources (P = .02), and the NCAA (P = .008) as sources of concussion information. Black athletes were more likely to report referees (P = .03) as a source of concussion knowledge. CONCLUSION Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion knowledge than White collegiate-athletes. The findings highlight the need for equitable strategies to disseminate concussion information to diverse populations by improving the physician-patient relationship and investing in culturally appropriate educational materials.
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Race and Concussion: An Emerging Relationship. Ochsner J 2021; 20:348-349. [PMID: 33408569 PMCID: PMC7755552 DOI: 10.31486/toj.20.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Noel-London KC, Grimsley C, Porter J, Breitbach AP. "The Tip of the Iceberg": Commentary on Sports, Health Inequity, and Trauma Exacerbated by COVID-19. J Athl Train 2021; 56:5-10. [PMID: 33290542 DOI: 10.4085/1062-6050-0350.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To discuss the relevance of system-level health inequities and their interplay with race in sports and athletic training, particularly during and after the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND Health inequity is a systemic and longstanding concern with dire consequences that can have marked effects on the lives of minority patients. As a result of the unequal consequences of the COVID-19 pandemic, the magnitude of the outcomes from health inequity in all spheres of American health care is being brought to the fore. The discourse within athletic training practice and policy must shift to intentionally creating strategies that acknowledge and account for systemic health inequities in order to facilitate an informed, evidence-based, and safe return to sport within the new normal. CONCLUSIONS To continue to evolve the profession and solidify athletic trainers' role in public health spaces post-COVID-19, professionals at all levels of athletic training practice and policy must intentionally create strategies that acknowledge and account for not only the social determinants of health but also the effects of racism and childhood trauma on overall health and well-being.
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Affiliation(s)
| | | | | | - Anthony P Breitbach
- Department of Physical Therapy and Athletic Training, Saint Louis University, MO
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Wallace J, Affagato R, Brooke M, McAllister-Deitrick J, Moran RN, Covassin T. Racial disparities in parent knowledge of concussion and recognition of signs and symptoms. JOURNAL OF SAFETY RESEARCH 2020; 75:166-172. [PMID: 33334474 DOI: 10.1016/j.jsr.2020.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians. METHODOLOGY This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses. RESULTS Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ± 4.55 (85.6% correct)], and African American parents/guardians [35.15 ± 4.97, 78.1% correct)] were identified (F(1,172) = 4.82, p = 0.03). CONCLUSION Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed.
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Affiliation(s)
- Jessica Wallace
- The University of Alabama, Department of Health Science, Tuscaloosa, AL 35401, United States.
| | - Rachel Affagato
- Youngstown State University, Department of Kinesiology & Sport Science, Youngstown, OH 44555, United States
| | - Maxwell Brooke
- Youngstown State University, Department of Kinesiology & Sport Science, Youngstown, OH 44555, United States.
| | | | - Ryan N Moran
- The University of Alabama, Department of Health Science, Tuscaloosa, AL 35401, United States.
| | - Tracey Covassin
- Athletic Training Program, Michigan State University, 105 IM Circle, East Lansing, MI 48840, United States.
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Wallace J, Moran R, Bretzin A, Hileman B, Huang GS. Examination of Racial Disparities in Adolescents Seen in the Emergency Department for Head, Neck, or Brain Injury. J Emerg Med 2020; 59:783-794. [PMID: 32893067 DOI: 10.1016/j.jemermed.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the frequency, severity, and attention of traumatic brain injury in children, benchmarking disparities and injury characteristics for adolescent patients is pivotal in understanding and enhancing both clinical care and outcomes. OBJECTIVES The purpose of this study was to investigate racial disparities on mechanism of injury, clinical outcomes, and social-health factors among adolescents treated in the emergency department (ED) for a head, neck, or brain injury. METHODS This study is the result of a retrospective chart review of head-, neck-, and brain-injured adolescent patients (n = 2857) treated at three community hospital EDs and one stand-alone ED. Outcome measures included patient demographics (gender, race/ethnicity, age), Glasgow Coma Scale score, hospital length of stay, intensive care unit length of stay, mechanism of injury, primary diagnosis, secondary diagnosis of a concussion, ventilation days, discharge disposition, and primary insurance. RESULTS There were racial differences in primary diagnosis, mechanism of injury, and insurance status. Results indicated that a higher proportion of white patients were diagnosed with a concussion compared with black patients (p < 0.001). Moreover, a higher proportion of white patients were seen in the ED for head, neck, or brain injury as a result of a sports or motor vehicle incident, whereas a leading mechanism among black patients was assault (p = 0.01). More white patients had private insurance, whereas more black patients had Medicaid (p < 0.001). CONCLUSION The disparities in mechanisms for which black and white adolescent patients are seeking care at the ED for head, neck, or brain injury help to identify social-health risks of sustaining a head, neck, or brain injury. These racial disparities between black and white adolescents seen at the ED for head, neck, or brain injury suggest the need for further research to better understand the national representation of these disparities.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ryan Moran
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama
| | - Abigail Bretzin
- Department of Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barbara Hileman
- Trauma and Neurosciences Research, Mercy Health, St. Elizabeth Youngstown Hospital, Youngstown, Ohio
| | - Gregory S Huang
- Department of Trauma, Mercy Health, St. Elizabeth Youngstown Hospital, Youngstown, Ohio
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Campbell J, Howland J, Hess C, Nelson K, Stern RA, Torres A, Olshaker J. Disparities in baseline neurocognitive testing for student concussion management in Massachusetts high schools. BMJ Open Sport Exerc Med 2020; 6:e000752. [PMID: 32537243 PMCID: PMC7264696 DOI: 10.1136/bmjsem-2020-000752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE There is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to assess whether the scope of testing is associated with the economic status of student populations in MA. METHODS A cross-sectional secondary analysis of surveys conducted with MA athletic directors (n=270) was employed to investigate school characteristics associated with the provision of BNT. Correlation and regression analyses were used to assess whether the scope of testing is associated with the economic status of student populations in MA. RESULTS The scope of BNT was independently associated with the economic disadvantage rate (EDR) of the student population (β=-0.02, p=0.01); whether or not the school employs an athletic trainer (AT) (β=0.43, p=0.03); and school size (β=-0.54, p=0.03). In a multivariable regression model, EDR was significantly associated with the scope of baseline testing, while controlling for AT and size (β=-0.01, p=0.03, adj-R2=0.1135). CONCLUSION Among public high schools in MA, disparities in the provision of BNT for students are associated with the economic characteristics of the student body. Schools that have a greater proportion of low-income students are less likely to provide comprehensive BNT. The clinical implications of not receiving BNT prior to concussion may include diminished quality of postconcussive care, which can have short-term and long-term social, health-related and educational impacts.
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Affiliation(s)
- Julia Campbell
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Jonathan Howland
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Courtney Hess
- Department of Counseling & School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kerrie Nelson
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Robert A Stern
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alcy Torres
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Jonathan Olshaker
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
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Lyons TW, Miller KA, Miller AF, Mannix R. Racial and Ethnic Differences in Emergency Department Utilization and Diagnosis for Sports-Related Head Injuries. Front Neurol 2019; 10:690. [PMID: 31312172 PMCID: PMC6614199 DOI: 10.3389/fneur.2019.00690] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Kelsey A Miller
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Andrew F Miller
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
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Marulanda-Londoño ET, Bell MW, Hope OA, Leacock RO, O'Carroll CB, Posas J, Stover NP, Young R, Hamilton R. Reducing neurodisparity: Recommendations of the 2017 AAN Diversity Leadership Program. Neurology 2019; 92:274-280. [PMID: 30659140 DOI: 10.1212/wnl.0000000000006874] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 12/06/2018] [Indexed: 11/15/2022] Open
Abstract
Many advances in prevention, diagnosis, and treatment of neurologic disease have emerged in the last few decades, resulting in reduced mortality and decreased disability. However, these advances have not benefitted all populations equally. A growing body of evidence indicates that barriers to care fall along racial and ethnic lines, with persons from minority groups frequently having lower rates of evaluation, diagnosis, and intervention, and consequently experiencing worse neurologic outcomes than their white counterparts. The American Academy of Neurology (AAN) challenged its 2017 Diversity Leadership Program cohort to determine what the AAN can do to improve quality of care for racially and ethnically diverse patients with neurologic disorders. Developing a fuller understanding of the effect of disparities in neurologic care (neurodisparity) on patients is an important prerequisite for creating meaningful change. Clear insight into how bias and trust affect the doctor-patient relationship is also crucial to grasp the complexity of this issue. We propose that the AAN take a vital step toward achieving equity in neurologic care by enhancing health literacy, patient education, and shared decision-making with a focus on internet and social media. Moreover, by further strengthening its focus on health disparities research and training, the AAN can continue to inform the field and aid in the development of current and future leaders who will address neurodisparity. Ultimately, the goal of tackling neurodisparity is perfectly aligned with the mission of the AAN: to promote the highest-quality patient-centered neurologic care and enhance member career satisfaction.
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Affiliation(s)
- Erika T Marulanda-Londoño
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Michelle W Bell
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Omotola A Hope
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Rodney O Leacock
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Cumara B O'Carroll
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Jose Posas
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Natividad P Stover
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Richard Young
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia
| | - Roy Hamilton
- From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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