Disparities of Care in Post-Concussive Pediatric Patients

Objective The objective of this study was to examine the association between insurance status and prevalence of follow up care at a tertiary referral center compared to the emergency department.

Background Concussions are extremely common in today's society, affecting patients of all demographic backgrounds. There is concern that public insurance status may affect follow up care at tertiary treatments centers compared to children with private insurance, as evidenced by Copley et al. who documented insurance disparities between children presenting to a sports medicine clinic with orthopedic injuries verses concussion.

Design/Methods We compared insurance status of patients presenting to our pediatric concussion clinic to the insurance status of patients diagnosed with concussion at the emergency department of our tertiary hospital. From 2018 to 2019, 725 patients received an ICD-10 diagnosis code for concussion in our clinic. Patients were excluded if insurance status was not available for the clinic visit (4), or if they were lost to follow up (380). ICD-10 codes for concussion during the same period were recorded from the COA emergency department (ED). The insurance status was then recorded for each patient.

Results Of the 345 patients included from the COA concussion clinic, 253 (73%) patients had private insurance while only 92 (27%) had public insurance. In comparison, of the 1,160 patients diagnosed with concussion in the COA ED, 642 (55%) patients had private insurance, 478 (41%) had public insurance, 37 (3.1%) were self-pay, and 3 (0.3%) were listed as “other.”

Conclusions There is a significant difference in the insurance status of patients with concussion that present to the COA ED when compared to those presenting to concussion clinic. As a result, children with public insurance may have prolonged recovery and more significant symptoms burden compared to children with private insurance.