82 - Post Concussion Predictors of Lost to Follow-Up Care

Publication Number: 2078.82

Anita Herrera Hamilton, Children's Hospital, Los Angeles, Seal Beach, CA, United States; Yeng Vue, University of California, Merced, Fresno, CA, United States; Becket Wren, Children's Hospital Los Angeles, Palos Verdes Estates, CA, United States; Gabriella G. Griego, Children's Hospital Los Angeles, West Covina, CA, United States; Madison Blackwell, Children's Hospital Los Angeles, Indianapolis, IN, United States; Ryan Kelln, Children's Hospital Los Angeles, Los Angeles, CA, United States; Tishya A. L.. Wren, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Concussion and mild traumatic brain injury (mTBI) affect millions of children and adolescents annually, with approximately 2.3 million diagnoses in 2022. Pediatric patients are particularly vulnerable to complicated recovery, necessitating careful follow-up to mitigate persistent post-concussion symptoms such as headaches, cognitive difficulties, and balance issues. Previous research demonstrates wide variability in follow-up rates (13.2%-99.5%), influenced by factors such as age, language, injury severity, insurance type, and geographic location. Non-English-speaking patients and those with public or no insurance are at increased risk for poor follow-up care, while sports involvement and living with biological parents are protective. Parental attitudes regarding follow-up care also impact treatment compliance.

Objective: To identify factors associated with being lost to follow-up among pediatric patients diagnosed with concussion, with close attention to demographic and clinical predictors.

Design/Methods: This study examined demographic and clinical predictors of being lost to follow-up among pediatric concussion patients in a large tertiary children's hospital system. Medical records were reviewed for age, gender, primary language, insurance type, Child Opportunity Index (COI), injury mechanism, symptom severity, and timing of visits. Lost to follow-up was defined as failure to attend recommended follow-up evaluations; clearance indicated return to baseline activity. Symptom scores were derived from a standardized checklist adapted from the Child SCAT-5.

Results: Among 419 concussions in 360 patients, 48.9% (205/419) were lost to follow-up. Simple logistic regression revealed that patients whose primary language was not English were over three times as likely to be lost to follow-up (OR=3.19, p=0.001), while private insurance (OR=0.50, p=0.001), higher COI scores (OR=0.99, p=0.003), and sports injury mechanism (OR=0.42, p< 0.001) were protective (Table 1). Delays in initial visit and longer time to release increased risk. In multiple logistic regression, only sports injury mechanism (OR=0.40, p< 0.001) and non-English primary language (OR=2.72, p=0.007) remained significant predictors (Table 2).

Conclusion(s): These findings highlight the need for targeted interventions to improve follow-up care, particularly among pediatric concussion patients whose primary language is not English. Enhanced communication and culturally sensitive family education may help reduce disparities and improve outcomes in this vulnerable population.

Table 1: Simple Logistic Regression Results with Lost to Follow-up as Dependent Variable
All primary language non-English were Spanish except 1 Arabic

Table 2: Final Multiple Logistic Regression with Lost to Follow-up as Dependent Variable