Study reveals opportunity to improve care of assault-related concussion.

Margaret Means, MD, is a fourth-year resident in Child Neurology at CHOP.

Our nation’s children are facing an epidemic of violence. This was highlighted in the New England Journal of Medicine article in December 2018 that found that firearm-related injuries were the second leading cause of death in children behind motor vehicle crashes. As a Child Neurology trainee, I became interested in investigating how violence impacts our neurology patients. After connecting with the Center for Injury Research and Prevention (CIRP), Center for Violence Prevention (CVP), and Minds Matter Concussion Program, I joined a team interested in evaluating assault-related concussion in patients at CHOP.

We conducted a study examining a retrospective cohort of 62 children with sports-and-recreation-related concussion (SRC) and 62 children with assault-related concussion (ARC) who presented for care within the CHOP Care Network and found important differences between them. Children with ARC were more likely to be Black, publicly insured, and present to the Emergency Department (ED) compared to children with SRC. Children with ARC were 2.8 times less likely to receive concussion-specific diagnostic testing in the form of a visio-vestibular examination during their initial evaluation. More than twice as many children with ARC reported a decline in grades compared to children with SRC. Children with ARC had a more extended recovery trajectory than their peers who sustained sports-related injuries.

While more research into the factors contributing to the differences in children with ARC is needed, providers can take some important initial steps. During an initial assessment, consider using standardized concussion evaluation tools (such as visio-vestibular testing) in any child with head trauma, regardless of injury mechanism. Consider early referral to concussion specialists in children with ARC due to their higher risk for prolonged recovery. Children with concussion from assault may particularly struggle with school re-entry, so providers should specifically inquire about school performance and partner with parents to increase school-based academic supports.

References and additional reading

Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med. 2018;379(25):2468-2475.

Means MJ, Myers RK, Master CL, Arbogast KB, Fein JA, Corwin DJ. Assault-related concussion in a pediatric population. [Published online ahead of print March 1, 2022.] Pediatric Emergency Care.

Visio-vestibular Markers for Concussion. Center for Injury Research and Prevention. program/objective-measures-concussion/visio-vestibular-markers-concussion. Accessed March 14, 2022.

Wallace JS, Mannix RC. Racial disparities in diagnosis of concussion and minor head trauma and mechanism of injury in pediatric patients visiting the emergency department. J Pediatr. 2021;233:249-254.e1.

Next Steps
Provider Priority Line: Dial 800-TRY-CHOP and Press 2
Central Fax Line (844-FAX-CHOP)