Research In Action

Advancing health equity for pediatric patients with concussion – ensuring that optimal care is delivered regardless of who patients are, how and where their injury occurs, and when and where following injury they are seen – is a core goal of the Minds Matter Concussion Program at Children’s Hospital of Philadelphia (CHOP). The reason for this is clear: prompt access to up-to-date and individualized concussion care strategies improves health outcomes. 

In collaboration with investigators from the Center for Health Equity at CHOP and the Centers for Disease Control and Prevention (CDC), Minds Matter investigators recently published an article in JAMA Network Open, where we utilized the Minds Matter Concussion Registry to explore differences in pediatric concussion patients based on where they first sought care following injury. Among over 15,000 pediatric patients presenting across the CHOP Care Network for concussion from 2017-2023, we found key differences in both individual- and neighborhood-level markers of vulnerability and opportunity. 

Those who first sought care in the emergency department (ED) differed in age, race, ethnicity, insurance status and the Child Opportunity Index compared to those who first sought care in specialty care. (See graphic below.) These findings show that our most vulnerable concussion patients are being cared for in a setting (the ED) less equipped (due to time limitations and lack of the ability to offer longitudinal care) to provide ideal concussion management. 

A Call to Action for Clinicians and the Community 

Simply identifying disparities does not advance health equity. We see this study as a call to action for interventions in two key areas: 

1. Emergency medicine clinicians should receive up-to-date, streamlined, and easy-to-implement tools that empower them to diagnose and provide guidance on managing pediatric concussion. 

Minds Matter remains an international leader in this work through the following research and collaborations: 

• We have made significant strides, as part of a NIH-funded effort, in our investigation of remote patient monitoring tools as a way to follow the progress of concussion patients first seen in the ED setting. 
• As part of our collaboration with the CDC, we have leveraged the electronic health record (EHR) to provide electronic clinical decision support for frontline providers regarding concussion diagnoses and identification of those patients in need of more targeted care. 
• With support from Toyota Motor North America and the Way Forward Fund, and in partnership with Corewell Health, we have implemented aspects of the Minds Matter Care Model in community emergency departments across the state of Michigan. 
• We have developed a series of online trainings, including didactics and video demonstrations, through the CHOP OPEN education platform. These include the latest recommendations in concussion management for acute care providers. 

2. Community members who interact with pediatric concussion patients – from the school setting to after school programs and sports teams – need more resources to both identify concussions and assist with concussion management. 

Thinking beyond the healthcare system, we feel strongly this work demonstrates the need to develop concussion-aware communities that can support patients who utilize the ED for concussion care. Often, follow-up care for these patients may not be as intuitive or streamlined when compared with those seeking care in specialty settings. 

In line with our findings, Minds Matter has committed time and resources to provide communities with the education and training that can lead to better health outcomes when a head injury is suspected or occurs. 

• Support from the Toyota Way Forward Fund has allowed us to collaborate with school districts in Lincoln Park, Michigan, and Bastrop, Texas to evaluate the feasibility of a Concussion-Aware School Model. This work would create alignment between school personnel, students, and caregivers on goals for concussion recovery. 
• We continue to investigate barriers that school nurses and coaches in urban settings face when implementing concussion management strategies. 
• In 2024, we began training within the Philadelphia Department of Parks and Recreation on concussion management strategies. This has given staff, counselors, and leadership the resources and tools they need to better identify and respond to head injuries, as well as guidance for re-integrating youth into activities after injury. 
• School students across the CHOP service area, most recently in Bucks County in suburban Philadelphia, have received training in concussion management and rehabilitation strategies. 

We see this work as an important first step in a journey to explore effective methods that are easy to implement across all settings to ensure that all concussion patients are receiving the highest level of care possible.