Study Shows Differences Between Concussions Sustained From Assaults and Sports-Related Injuries
According to research published in Pediatric Emergency Care, adolescent children with assault-related concussion were less likely to receive a concussion diagnosis test, had extended recovery outcomes, and were more than twice as likely to experience a decline in academic performance than those with sport-related concussions.
Most assault-related concussions were in Black adolescents, who had Medicaid, Medicare, or other public insurance and were diagnosed in the emergency department. Adolescents with assault-related concussions were less likely to receive a concussion-specific visio-vestibular examination (27%) compared with adolescents who had sport-related concussions (74%)(P<.001). Twice as many adolescents with assault-related concussions (47%) saw a decline in their school grades compared with adolescents with sports-related concussions (20%) (P=.012). Assault-related concussions also had longer recovery periods due to symptoms.
"Given the current research and clinical focus on sports-related concussions, when a patient seeks care following an assault, providers may not necessarily have concussion at the top of their minds," said Margaret Means, MD, a child neurology resident in the Division of Neurology at CHOP and lead author of the study. "In addition, much of the education and awareness surrounding concussion has focused on sport-related concussion and, as a result, clinicians caring for non-sports-related mechanisms of injury may not think of approaching assault-related concussion in the same way. The implications of this study are quite important to ensure equitable care for concussion patients."
"From our violence prevention work, we are well aware of the large number of children and adolescents who experience concussions as a result of violence and may not have access to the same levels of support as youth who experience sport-related concussion," said co-author Rachel Myers, PhD, MS, codirector of the Community Violence and Trauma Support programming at the Center for Violence Prevention at CHOP. "Understanding the possible disparities in diagnosis, treatment, and recovery is vitally important in enhancing our efforts to support violently injured youth's physical and psychosocial recovery."
This study evaluated 124 adolescents, 62 had an assault-related concussion and 62 had a sports-related concussion. Participants were age 8 to 17 years, received a concussion diagnosis at the beginning of the study when they visited the hospital, and were evaluated for a 2-year period.
"These results support the idea of creating standardized evaluation tools, including symptom assessment and visio-vestibular testing, for all patients presenting with head injuries, regardless of injury mechanism," said senior author Daniel J. Corwin, MD, MSCE, assistant professor of Pediatrics at the University of Pennsylvania and Associate Director of Research for the Division of Emergency Medicine at CHOP. "In particular, routine visio-vestibular testing has the potential to improve diagnostic accuracy and tailor the anticipatory guidance of providers in predicting recovery. Its routine use is a valuable tool in minimizing care disparities."