Vanderbilt University Medical Center (Nashville, TN)
April 28th, 2022
Both Black and white young athletes who suffered concussions while within a sport-related concussion (SRC) clinic referral network did not experience health disparities related to their care, according to a study in the April issue of the Journal of Athletic Training, the National Athletic Trainers’ Association (NATA) scientific journal.
Previous studies have shown that, even after accounting for factors such as insurance, severity of disease, income status, and educational levels, Black patients recovered earlier and missed less school than their white counterparts, raising concern for differential care quality.
“Sport-related concussions are a public health concern, particularly among pediatric and adolescent populations, where one in five athletes has reported sustaining a concussion in their lifetime,” said lead author Aaron Yengo-Kahn, MD, co-director of Research in the Vanderbilt Sport Concussion Center at Vanderbilt University Medical Center.
“Diversity among these athletes matters. We know that seeking care for sport-related concussions is not consistent across demographics, and that can stem from health inequities and lead to further disparities,” he said.
A total of 582 middle and high school athletes — 486 (83%) white and 96 (17%) Black — in the retrospective cohort study were diagnosed with a sports-related concussion and evaluated at the Vanderbilt Sport Concussion Center between Nov. 1, 2017, and Oct. 1, 2020.
The four primary outcomes were (1) location of the first health system contact, (2) time from injury to the first health system contact, (3) time to the in-person SRC clinic visit, and (4) whether the athlete established care, was released immediately to an athletic trainer, or was lost to follow-up.
Nearly two-thirds of Black and white athletes in the study sought sport-related concussion care initially at the concussion clinic compared with the emergency department or other medical clinic.
“We demonstrated that, within an established SRC referral network and multidisciplinary clinic, there were no observed racial disparities in how athletes were initially managed or ultimately presented to the SRC clinic, despite racial differences in school type and insurance coverage,” said study author Jessica Wallace, PhD, MPH, LAT, ATC, Athletic Training Program, Department of Health Science, The University of Alabama, Tuscaloosa.
Study authors also found that the presence of an athletic trainer is integral to the care pathway and may help to reduce disparities — 40% of Black athletes and 30% of white athletes were released to the athletic trainer to carry out return-to-play protocols as a final sequence of care.
“The athletic trainer remains a cornerstone of that care and can be a resource to help athletes and families navigate medical spaces, though previous researchers have demonstrated disparities in access to athletic trainers,” Wallace said.
“Results from this study provide a health equity-focused example of a health care network model that can reduce disparities and facilitate the continuity of care for patients with SRC,” she said.
Other study findings include:
Black athletes more frequently reported loss of consciousness than white athletes, whereas amnesia was similarly reported by both groups.
Black and white athletes demonstrated no significant difference in the prevalence of on-field evaluation post-injury or the time to the first health system contact.
The initial system contact setting was not different by race.
“Ensuring equal access of care for sports-related injuries and illnesses is certainly an integral part of our best practices,” said NATA President Kathy Dieringer, EdD, LAT, ATC.
“This study provides a clear roadmap to equitable care and demonstrates that a multidisciplinary network including athletic trainers and Emergency Department physicians can expedite care and recovery.”