From the Divisions of Neurology.
Pediatr Emerg Care. 2022 Sep 1;38(9):e1503-e1507. doi: 10.1097/PEC.0000000000002664. Epub 2022 Mar 4.
The aim of this study was to compare demographic characteristics, medical care, and outcomes among patients with assault-related concussion (ARC) versus sports and recreation-related concussion (SRC).
We conducted a retrospective chart review of 124 patients (62 ARC, 62 SRC) aged 8 to 17 years presenting to the care network of a large tertiary care pediatric hospital between July 1, 2012, and June 30, 2014 with a concussion diagnosis at time of presentation. We abstracted patient demographics, initial medical care visit characteristics, and outcome data, and compared proportions using χ2 testing and Fisher exact test and medians using Wilcoxon rank sum test.
Patients with ARC were more likely to be Black, publicly insured, and present first for care to the emergency department. Significantly fewer patients with ARC received visio-vestibular testing at initial visit (27% vs 74%, P < 0.001). During recovery, the total number of reported physical, cognitive, emotional, and sleep symptoms did not differ between groups; however, more than twice as many patients with ARC reported decline in grades postinjury compared with patients with SRC (47% vs 20%, P = 0.012). There were trends toward prolonged symptom recovery and time to physician clearance for full return to activities among patients with ARC compared with SRC.
This study highlights potential disparities in the initial evaluation and outcomes of pediatric concussion patients based on mechanism of injury. Patients with ARC were less likely to receive a concussion-specific diagnostic evaluation and reported a greater impact on educational outcomes, suggesting differences in concussion diagnosis and management among assault-injured patients. Further examination in larger populations with prospective studies is needed to address potential inequities in concussion care and outcomes among patients with ARC.
本研究旨在比较与意外伤害相关的脑震荡（ARC）和与运动/娱乐相关的脑震荡（SRC）患者的人口统计学特征、医疗保健和结局。
我们对 2012 年 7 月 1 日至 2014 年 6 月 30 日期间在一家大型三级儿科医院就诊网络中因脑震荡就诊的 124 名 8 至 17 岁患者（62 例 ARC，62 例 SRC）进行了回顾性图表审查。我们提取了患者的人口统计学特征、初始医疗就诊特征和结局数据，并使用 χ2 检验和 Fisher 精确检验比较比例，使用 Wilcoxon 秩和检验比较中位数。
ARC 患者更有可能是黑人、公共保险和首次到急诊就诊。初次就诊时，接受视动测试的 ARC 患者明显较少（27%比 74%，P<0.001）。在恢复期间，两组患者报告的身体、认知、情绪和睡眠症状总数没有差异；然而，ARC 患者报告受伤后成绩下降的比例明显高于 SRC 患者（47%比 20%，P=0.012）。与 SRC 患者相比，ARC 患者的症状恢复时间和医生完全清除活动的时间有延长趋势。
本研究强调了根据损伤机制，儿童脑震荡患者的初始评估和结局存在潜在差异。ARC 患者接受特定于脑震荡的诊断评估的可能性较小，报告对教育结局的影响更大，这表明在脑震荡诊断和管理方面，受伤的攻击患者存在差异。需要在更大的人群中进行前瞻性研究，以解决 ARC 患者脑震荡护理和结局方面的潜在不平等问题。
