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TOPLINE:

A population-level cohort study found that patients from more marginalized neighborhoods and rural areas were more likely to present to emergency departments (EDs) for concussion and were less likely to complete an outpatient follow-up visit.

METHODOLOGY:

• Researchers conducted a population-based cohort study of 674,629 patients (mean age, 32.8 years; 52.9% women) with concussion using linked administrative databases in Ontario between 2010 and 2023.
• Patients were stratified into four age groups (< 18, 18-39, 40-64, and ≥ 65 years) and assessed for individual-level factors (age, sex, immigrant status, presence of a family physician, and rurality) as well as neighborhood-level socioeconomic markers (income quintile and Ontario Marginalization Index [ON-Marg] domains of material resources, households/dwellings, and racialized/newcomer populations).
• The primary outcome was the initial location of concussion care (ED vs outpatient settings). The secondary outcome was an outpatient follow-up visit within 30 days of the index visit.

TAKEAWAY:

• Patients in the most marginalized quintile of the ON‑Marg Material Resources domain were more likely to present to the ED than to outpatient settings (20.4% vs 14.4%) and had higher adjusted odds of ED presentation than those in the least marginalized quintile (odds ratio [OR] for age < 18 years, 1.58).
• Across all age groups, the absence of a family physician was associated with markedly higher odds of ED presentation (OR, 4.71 among individuals aged 18-39 years). Residing in rural areas was also associated with higher odds of ED presentation (OR, 1.56 among individuals aged 18-39 years).
• Being in the most marginalized quintile on the Racialized and Newcomer Index was associated with greater odds of presenting to outpatient settings than to ED settings (for instance, the OR for ED vs outpatient settings was 0.61 among patients younger than 18 years).
• Patients first presenting to outpatient settings were more likely to have a follow-up visit within 30 days (28.1% vs 8.7%). Among patients aged 65 years or older, an initial ED visit (OR, 0.21), residence in the most marginalized quintile for material resources (OR, 0.74), and not having a family physician (OR, 0.29) were associated with lower odds of completing an outpatient follow-up visit within 30 days.

IN PRACTICE:

"These findings emphasize the importance of augmenting health care system-wide resources, including primary care access, telemedicine, and streamlined education tools, in addition to enhancing resources for ED clinicians, to optimize concussion care across all ages," the authors concluded.

SOURCE:

The study was led by Daniel J. Corwin, MD, MSCE, Children's Hospital of Philadelphia, Philadelphia. It was published online on April 22, 2026, in JAMA Network Open.

LIMITATIONS:

The reliance on administrative data may have resulted in misclassification and precluded the assessment of injury mechanism and severity. Neighborhood-based marginalization measures may not have reflected individual circumstances or recent changes. Additionally, immigration records were incomplete, individual race and ethnicity data were unavailable, and clinic type and nonphysician follow-up visits were not captured, limiting the evaluation of disparities and care pathways.

DISCLOSURES:

The study was supported by the Ontario Brain Institute and an award from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Two authors reported receiving research funding and having ties with various organizations, including 360 Concussion Care and multiple funding agencies. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.