372 - Examination of Disparities in Concussion Care Referral Practices in a Primary Care Network

Poster Number: 372
Publication Number: 372.1270

Background: Nearly 2 million pediatric concussions or mild traumatic brain injuries (mTBI) occur annually. The vast majority of pediatric mTBI patients are first evaluated by their primary care provider (PCP). Disparities in pediatric mTBI outcomes are unequally borne across socio-demographic groups and it is critical to understand the role of referral practices by PCPs that may play a role in such disparities.

Objective: Describe disparities in pediatric mTBI referral practices from PCP using a prospective mTBI registry of a large pediatric healthcare system.

Design/Methods: Data were queried from the Minds Matter Concussion Registry, a prospective cohort drawn from the electronic health record (EHR) of a large, regional healthcare system that includes a primary care network of over 30 locations. This analysis examined data for patients seen by their PCP between 7/5/22-6/30/23 who were aged 5–18 years and diagnosed with a concussion ≤10 days of injury. Descriptive statistics were used to describe the sociodemographic (including Child Opportunity Index (COI) scores based on the patient’s residential zip code) and injury characteristics. Univariate and multivariate regression were used to assess the associations of sociodemographic characteristics and two outcomes, 1) referral to specialty care ≤28 days of injury and 2) requiring care >28 days.

Results: Table 1 includes the sociodemographic characteristics of the 943 patients who met inclusion criteria. A total of 115 patients (12.2%) were referred to specialty care from primary care ≤28 days from injury. In the adjusted model, older age (OR:1.09, CI:1.02-1.16) and greater initial symptom burden (OR:1.11, CI:1.04-1.18) were significantly associated with a referral to specialty care (Table 2), while those with private insurance were less likely to be referred (OR:0.53, CI:0.33-0.86). A total of 148 patients (16%) had their last visit for concussion care >28 days of injury. In the adjusted model, female sex and positive referral status were significantly associated with requiring care >28 days. There was no association of race, ethnicity, or COI in either adjusted model.

Conclusion(s): In this large prospective cohort, most patients were managed in primary care throughout their clinical course, with approximately 12% referred to specialty care. The primary care system serves patients that have a range of socioeconomic resources. There were few differences by sociodemographic characteristics in mTBI outcomes related to referral and visits >28 days. This data supports equitable care delivery by PCPs once concussed youth enter their care.