Concussions & Race: Does Race Impact Care

Let’s Start Highlighting the Issues

In our posts here at HeadCheck Health, we often look at the increased vulnerabilities of children or females when it comes to concussive injury. What is often not talked about are concussions and if there are any racial differences. While some studies have shown racial differences in concussion awareness and outcome – white athletes have increased knowledge about concussions in comparison to Black athletes and race was a significant predictor as to which children received neuroimaging, respectively – again, it’s not necessarily highlighted, talked about, addressed in meaningful ways, etc. (1-3).

*Please note that the author used the terms used by the researchers in distinguishing between people of different races.

What’s This Study About?

Today we are going to look at a study published in 2019 that doesn’t look at racial and ethnic differences in concussion knowledge, incidence, or severity. Rather, it looks at the racial and ethnic differences in emergency department utilization and diagnosis for sports-related head injuries. Given today’s climate in terms of fighting for racial equity and justice, this is an important topic to explore.

Using the National Electronic Injury Surveillance System that collects data from roughly 100 hospitals all around the U.S., emergency department visits data for children aged 7-18 with a sports-related injury between 2008-2017 were examined in this study (4-5). Injuries came from youth participating in baseball, basketball, cheerleading, field hockey, American football, gymnastics, ice hockey, lacrosse, rugby, soccer, softball, tennis, track and field, volleyball, and wrestling. The research team identified 11,529,994 pediatric sports-related injury emergency department visits. 13% (1,497,717) of those injuries were injuries to the head and less than half (5.4% – 619,714) of the injuries received a concussion diagnosis.

Race Is a Significant Factor in Care Received

This study resulted in two key findings. First, Black children were nearly 30% less likely than non-Hispanic white children to have their visit to the emergency department be for a head injury and 40% less likely to be for a diagnosis of concussion.* Second, for Black children who came to the emergency department with a head injury, they were 30% less likely than non-Hispanic white children to be diagnosed with a concussion. Relatedly, this latter difference was more pronounced in football, soccer, basketball, and cheerleading; this is significant because these sports are associated with higher rates of head trauma (6).

The study highlights that there are racial differences between emergency department utilization which may suggest inequitable accessibility for certain populations. The research team speculated that these racial differences in ED utilization could be due to factors including: “differences in the recognition of signs and symptoms of head injuries, differences in level of concern about head injuries, access to certified athletic trainers, differences in where patients seek initial care for head injuries, and differences in referral patterns to the ED for head injuries” (1, 7-8). I would like to point out however, that this also may point to accessibility issues as a result of cost of health care in the, location of hospital and transportation issues, fear of being discriminated against, or any number of inter-related systemic issues that may prevent persons of the Black community from going to the hospital. Furthermore, the study highlights that for some reason, white children are more likely to be diagnosed with a concussion which seems to point to “potential racial bias in the evaluation and diagnosis of head-injured athletes” (9).

Further Harm

These findings are not only concerning due to the seemingly overt racism and the clear issues of equity when it comes to accessing and receiving health care for this population. These findings are concerning because if Black children are not seeking health care from a professional and are not being diagnosed with concussion (whether they seek health care or not), they are opening themselves up to potentially further exacerbating the injury (let’s say if they continue to play sport unknowingly having a concussion); making them susceptible to further, more severe injury; and/or prolonging the recovery of the injury. As the researchers say regarding the two main findings of this study: “further work is needed to understand these differences to ensure all brain injured athletes receive optimal care, regardless of race.”

Works Cited

1. Wallace J, Covassin T, Moran R. Racial disparities in concussion knowledge and symptom recognition in American adolescent athletes. J Racial Ethn Heal Disparities. (2018) 5:221–8. doi: 10.1007/s40615-017-0361-1
2. Mannix R, Bourgeois FT, Schutzman SA, Bernstein A, Lee LK. Neuroimaging for pediatric head trauma: do patient and hospital characteristics influence who gets imaged? Acad Emerg Med. (2010) 17:694–700. doi: 10.1111/j.1553-2712.2010.00797.x
3. Natale JE, Joseph JG, Rogers AJ, Mahajan P, Cooper A, Wisner DH, et al. Cranial computed tomography use among children with minor blunt head trauma: association with race/ethnicity. Arch Pediatr Adolesc Med. (2012) 166:732–7. doi: 10.1001/archpediatrics.2012.307
4. United States Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS). (2017). Available online at: https://www.cpsc.gov/Research–Statistics/NEISS-Injury-Data (accessed February 8, 2018).
5. Frame T, Buzas D, Jacobson NA, Morawa LG. Concussions from 9 youth organized sports: results from NEISS hospitals over an 11- year time frame. Orthop J Sports Med. (2014) 2:2325967114528460. doi: 10.1177/2325967114528460
6. Mannix R, Meehan W, Pascual-Leone A. Concussion: media, science and policy. Nat Rev Neurol. (2016) 12:486–90. doi: 10.1038/nrneurol.2016.99
7. Arbogast KB, Curry AE, Pfeiffer MR, Zonfrillo MR, Haarbauer-Krupa J, Breiding MJ, et al. Point of health care entry for youth with concussion within a large pediatric care network. JAMA Pediatr. (2016) 170:e160294. doi: 10.1001/jamapediatrics.2016.0294
8. Kroshus E, Rivara FP, Whitlock KB, Herring SA, Chrisman SPD. Disparities in athletic trainer staffing in secondary school sport: implications for concussion identification. Clin J Sport Med. (2017) 27:542–7. doi: 10.1097/JSM.0000000000000409
9. van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. (2003) 93:248–55. doi: 10.2105/AJPH.93.2.248