Pate James, Cummins Ian, Mooney James, Cooper Kasey, McLeod Chandler, Gould Sara
School of Medicine, University of Alabama at Birmingham, AL, United States.
Department of Neurosurgery, University of Alabama at Birmingham, AL, United States.
J Clin Neurosci. 2022 Jun;100:94-99. doi: 10.1016/j.jocn.2022.04.008. Epub 2022 Apr 14.
The objective of this study was to investigate predictors of concussion recovery in children (5-12) versus adolescents (13-18) while identifying economic and demographic disparities in post-concussion care at a tertiary referral concussion clinic versus emergency department (ED). Race and insurance status were recorded for patients presenting to the concussion clinic (724) and ED (1,160) with an ICD-10 concussion diagnosis between 2018 and 2019. Secondly, a subset of patients from the concussion clinic group were included for retrospective cohort review based on documented recovery data. Overall, the concussion clinic saw more Caucasian patients (66.7%) than the ED (56.8%). Concussion clinic patients were more likely to have Private insurance than ED patients (67.2% vs. 55.3%) and less likely to have Medicaid and Self pay (p < 0.001). Children were more likely to be hospitalized after concussion diagnosis than adolescents (40.8% vs. 24.4%, p = 0.006). Attending public school was associated with a 1.8 times greater hazard ratio (HR) for shorter time to recovery compared to attending private school. Additionally, presence of a diagnosed psychiatric disorder was associated with a HR of 0.5, indicating a longer time to recovery (p < 0.001) than patients without a disorder. The present findings may support limitations on contact sports participation in young children given their higher hospitalization rate after concussion. Additionally, the study highlights potential barriers to care amongst youth concussion patients with those seen in specialized concussion clinics more likely to be White and have private insurance.
本研究的目的是调查儿童（5 - 12岁）与青少年（13 - 18岁）脑震荡恢复的预测因素，同时确定三级转诊脑震荡诊所与急诊科（ED）在脑震荡后护理方面的经济和人口差异。记录了2018年至2019年间在脑震荡诊所（724例）和急诊科（1160例）就诊且诊断为ICD - 10脑震荡的患者的种族和保险状况。其次，根据记录的恢复数据，纳入了脑震荡诊所组的一部分患者进行回顾性队列研究。总体而言，脑震荡诊所的白人患者（66.7%）比急诊科（56.8%）更多。脑震荡诊所的患者比急诊科患者更有可能拥有私人保险（67.2%对55.3%），而拥有医疗补助和自费的可能性更小（p < 0.001）。脑震荡诊断后儿童比青少年更有可能住院（40.8%对24.4%，p = 0.006）。与上私立学校相比，上公立学校与恢复时间较短的风险比（HR）高1.8倍相关。此外，被诊断患有精神疾病与HR为0.5相关，这表明与没有精神疾病的患者相比，恢复时间更长（p < 0.001）。鉴于幼儿在脑震荡后住院率较高，目前的研究结果可能支持限制幼儿参加接触性运动。此外，该研究强调了青少年脑震荡患者在护理方面的潜在障碍，在专门的脑震荡诊所就诊的患者更有可能是白人且拥有私人保险。
