Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA; Department of Health Science, University of Alabama, Tuscaloosa, AL.
Departments of Pediatrics & Emergency Medicine, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
J Pediatr. 2021 Jun;233:249-254.e1. doi: 10.1016/j.jpeds.2021.01.057. Epub 2021 Jan 29.
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).
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.
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.
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.
确定在因脑震荡和轻度头部外伤（MHT）而到急诊就诊的儿童和青少年中，诊断和损伤机制是否存在种族/民族差异。
使用国家医院门诊医疗调查，完成了一项回顾性、横断面研究，对 2010 年至 2015 年期间因脑震荡就诊于急诊的患者（年龄≤19 岁）进行了研究。主要研究暴露因素为种族/民族。结果测量包括导致脑震荡/MHT 诊断的急诊就诊和损伤机制。机制类别包括运动、机动车碰撞、跌倒、攻击和其他机制。采用多变量逻辑回归和多项逻辑回归来评估种族/民族与结局之间的关系。研究结果进行了加权处理，以反映人口估计值。
共确定了 1263 例因脑震荡/MHT 就诊的儿童/青少年病例，代表全国范围内有 660 万例儿童/青少年就诊。与非西班牙裔白种儿科患者相比，非西班牙裔黑种患者最不可能因脑震荡/MHT 就诊（P<.001；比值比，0.66；95%置信区间，0.52-0.83）。非西班牙裔黑人儿童/青少年（比值比，3.80；95%置信区间，1.68-8.55）和其他种族/民族的儿童/青少年（比值比，4.93；95%置信区间，1.09-22.23）因攻击导致脑震荡/MHT 的可能性更高。
在对与运动相关的脑震荡的关注日益增加的情况下，这些在急诊诊断脑震荡/MHT 方面的种族/民族差异表明存在需要进一步关注的社会人口差异。攻击可能是少数族裔儿童/青少年脑震荡的更常见机制。
