Is Access to Optimal Concussion Care for Pediatric Athletes Limited by Geography?

Objective: To evaluate access to optimal concussion care based on a pediatric patients' geography; the hypothesis is that differential access across the Unites States exists.

Design: Employed a novel strategy using internet searches to find local care, mimicking what families might do in different parts of the country.

Setting: Virtual internet searches.

Participants: Not applicable.

Independent Variable: Various metropolitan and rural geographic regions within each state in the United States.

Main Outcome Measures: Evaluate access (defined as distance to clinic and ability to see pediatric patients) and optimal care (defined as self-referral process and presence of multidisciplinary care).

Results: Search strategy yielded 490 results. Overall ∼60% were within 50 miles of searched locations with significant differences in access based on rural versus metropolitan areas ( P < 0.0001); in rural areas, only ∼22% of results were within 50 miles. Only about one-third of the results (n = 157) saw pediatric patient with no differences between regions. There was significant regional and geographic variation for optimal care regarding both self-referral processes and access to multidisciplinary care. A diverse group of specialists was represented in search results for concussion care.

Conclusions: Nationwide, there is an overall lack of access to multidisciplinary concussion care for pediatric patients. Additionally, those in rural communities face more limitations related to access to facilities with increased distances from closest clinic sites.