Concussion Evaluation Patterns Among US Adults

Objective: The objective of this study was to compare individuals who were not evaluated by a doctor or nurse for a self-reported concussion versus individuals who were evaluated for a concussion by demographic variables, concussion history, and concussion circumstances. Settings and Participants: Data were collected from 2018 SpringStyles, a web-based panel survey of US adults 18 years or older (n = 6427), fielded in March-April. Design: Cross-sectional. Main Measures: Respondents were asked whether they believed they had sustained a concussion in their lifetime and details about their most recent concussion, including whether they were evaluated by a doctor or nurse. Results: Twenty-seven percent of adults in the survey reported a lifetime concussion (n = 1835). Among those individuals, 50.4% were not evaluated by a healthcare provider for their most recent concussion. Not being evaluated was higher among individuals whose concussion was caused by a slip, trip, or fall (adjusted prevalence ratio [APR] = 2.22; 95% CI, 1.65-2.99), riding a bicycle (APR = 2.28; 95% CI, 1.58-3.27), being struck by or against something by accident (APR = 2.50; 95% CI, 1.88-3.34), or being struck by or against something during a fight or argument (APR = 2.89; 95% CI, 2.11-3.97), compared with individuals whose concussion was caused by a motor vehicle crash. No evaluation was also higher among individuals whose concussion occurred while engaging in a sports or recreational activity (APR = 1.39; 95% CI, 1.07-1.82) or engaging in regular activities around the house (APR = 1.65; 95% CI, 1.27-2.14), compared with individuals whose concussion occurred while working for pay. Conclusion: More than a quarter of adults reported a lifetime concussion; however, half of them were not evaluated for their last concussion by a healthcare provider. Examination by a healthcare professional for a suspected concussion may prevent or mitigate potential long-term sequelae. Furthermore, current US surveillance methods may underestimate the burden of TBI because many individuals do not seek evaluation.