Toronto, ON, April 22, 2026 — Patients experiencing higher levels of socioeconomic marginalization and without established family physicians were more likely to seek initial concussion care in hospital emergency departments (EDs) rather than outpatient settings, according to a new study from ICES, the CHEO Research Institute , Children's Hospital of Philadelphia (CHOP), and the Ontario Brain Institute (OBI). These patients, particularly those without family physicians, were also significantly less likely to receive follow-up care within 30 days of their first visit.
"Most concussions can be managed in outpatient settings; however, prior research has shown that lower socioeconomic status contributes to higher ED-use for non-urgent health concerns, an issue compounded by the fact that due to time constraints, the ED is oftentimes the least optimal setting to deliver ideal concussion care," says Dr. Daniel Corwin, Associate Director and Emergency Department Lead of CHOP's Minds Matter Concussion Program and Director of Clinical and Translational Research for CHOP's Division of Emergency Medicine, and scientist within the TRANSCENDENT Concussion Research Program. TRANSCENDENT, funded by the OBI and led out of the CHEO Research Institute, combines large-scale clinical data with patient-centered research to answer priority questions in concussion care.
The population-based study examined 674,629 Ontarians across all age ranges diagnosed with concussion over a 13-year period. Overall, 41 per cent of patients first sought care in an ED. Compared with those who initially accessed outpatient care, ED-first patients were more likely to live in lower-income neighbourhoods with fewer material and household resources, reside in rural communities, and less likely to possess a family doctor. On the other hand, patients presenting from more diverse neighbourhoods were less likely to first seek care in EDs across all age groups.
Initial ED care was consistently associated with much lower follow-up rates, regardless of age, with the largest disparity observed among adults. Less than nine per cent of ED-first patients completed a follow-up visit within 30 days, compared with 28 per cent of those who first visited an outpatient clinic. Additional factors associated with fewer follow-ups included residing in a neighbourhood with fewer material resources and patients not having a regular family doctor. Patients without a family doctor were up to 70 per cent less likely to follow up.
"The findings highlight the very real need for system-wide improvements in concussion management, particularly for communities facing socioeconomic marginalization," says Dr. Corwin. "Improving access to primary care for all patients is critical to providing optimal concussion care, as is developing tools to support ED clinicians caring for concussion patients, and alternative care models, such as telemedicine or remote monitoring."
The study, "A population-based study exploring socioeconomic disparities in concussion presentation," is in the April issue of JAMA Network Open. The TRANSCENDENT team is actively evaluating innovative approaches such as remote monitoring and digital tools to help improve access, follow-up, and recovery for underserved patients.
ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. Our knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, follow us on BlueSky and LinkedIn: @ICESOntario
