A new study published in The Journal of Pediatrics explores how children from different backgrounds may experience unequal access to concussion care.
The study, “The Leaky Pipeline of Injury: Disparities at Multiple Junctures for Children with Head Trauma,” examined the healthcare journeys of more than 22,000 children who visited emergency departments for head injuries in the United States between 2018 and 2025.
What did the researchers find?
The researchers looked at three important steps in concussion care:
- Diagnosis: Was the child’s head injury diagnosed as a concussion?
- Referral: If diagnosed, was the child referred to specialized concussion care?
- Follow-up: If referred, did the child attend a specialty care appointment within 30 days?
At each step, the researchers found differences related to age, race and ethnicity, insurance coverage, and the opportunities available in a child’s neighbourhood.
For example, children who identified as non-Hispanic White, had private health insurance, or lived in neighbourhoods with greater opportunities were more likely to receive a concussion diagnosis, be referred to specialty care, and attend a follow-up appointment.
Of the 5,998 children diagnosed with a concussion, only 1,142 were referred to specialty care. Of those referred, 487 attended at least one specialty appointment within 30 days.
The researchers described this pattern as a “leaky pipeline of injury.” In other words, children can face barriers at several stages of the healthcare process, making it harder for some to receive the care they need.
Why does this matter?
Concussion care involves more than diagnosing an injury. Some children need specialized assessment, rehabilitation, and follow-up support to help them recover.
When children face barriers to diagnosis or treatment, they may miss out on care that could support their recovery. Families may also encounter practical challenges, such as arranging transportation, taking time off work, or finding and booking a specialty appointment.
These findings highlight why concussion care needs to be both accessible and equitable. Every child should have the opportunity to be assessed, receive appropriate referrals, and access follow-up care based on their needs — regardless of their background, insurance coverage, or where they live.
Making concussion care more equitable
The researchers suggest that more consistent assessment tools could help reduce differences in how head injuries are diagnosed and which children are referred for specialized care. They also highlight options such as telehealth appointments and remote monitoring to help families access follow-up support.
Improving access means looking at the entire care journey, not just the initial diagnosis. Healthcare providers and systems can work to identify barriers at each stage and make it easier for families to navigate the process.
Although this study focused on children in one US healthcare system, it raises important questions about how healthcare systems can better support children and families experiencing concussion.
Equitable concussion care means ensuring that every child has a fair opportunity to receive the assessment, treatment, and follow-up they need.
References
Corwin, D. J., Fedonni, D., Camacho, P., McDonald, C. C., Bryant-Stephens, T., Kendi, S. A. I., Master, C. L., & Arbogast, K. B. (2026). The leaky pipeline of injury: Disparities at multiple junctures for children with head trauma. The Journal of Pediatrics, 294, 115066. https://doi.org/10.1016/j.jpeds.2026.115066
