Research Letter: Concussion Evaluation by Injury Setting Among US Children

OBJECTIVE: To examine differences in medical evaluation for concussion after sports-related head trauma (SRHT) versus non-SRHT among school-aged children in the United States. SETTING: National Health Interview Survey. PARTICIPANTS: Children aged 5-17 years living in the United States. DESIGN: Caregiver-reported responses to questions on health topics among a nationally-representative sample of US children. MAIN MEASURES: Experience of concussion-like symptoms after head trauma in the prior year, injury setting, and receipt of medical evaluation for concussion from health professional. RESULTS: The study included 11,768 children aged 5-17 years in 2023-2024. An estimated 2.6% (95% confidence interval [CI], 2.3-2.9) reported concussion-like symptoms after head trauma in the prior year, with a higher prevalence among those aged 13-17 years (3.5%; 95% CI, 3.0-4.1). Most injuries occurred outside of sports settings (60.8%; 95% CI, 54.4-66.8). Overall, 67.7% (95% CI, 61.5-73.5) of injured children received a medical evaluation for concussion. Evaluations were more common among males than females (adjusted prevalence ratio [aPR], 1.249; 95% CI, 1.043-1.495) and those aged 13-17 years than aged 5-12 years (aPR, 1.366; 95% CI, 1.104-1.689). Concussion evaluations were administered to 90.4% of children with SRHT compared with only 53.1% with non-SRHT. Adjusting for relevant characteristics, we estimated medical evaluation occurred 39.2% less often for non-SRHT (aPR, 0.608; 95% CI, 0.505-0.733). Based on the 2023-2024 population estimates, this indicates approximately 388,905 (95% CI, 292,880-484,929) missed concussion evaluations for children with non-SRHT each year. CONCLUSION: These findings suggest substantially more missed concussion evaluations among children with concussion-like symptoms after non-SRHT compared with those with SRHT. Increasing awareness about concussion care among school personnel and health professionals that work with pediatric populations, and embedding clear guidance for referral and treatment into non-sports-related settings, may serve to reduce differences in evaluation and improve long-term recovery.