New Study Finds Socioeconomic Barriers Drive Emergency Department Use for Concussion Care
April 22, 2026
A new peer-reviewed study from TRANSCENDENT, the Ontario Brain Institute's (OBI) Integrated Discovery Program focused on concussion research, has found that Ontarians experiencing higher levels of socioeconomic marginalization, and those without a regular family physician, are significantly more likely to seek initial concussion care in hospital emergency departments (EDs), and far less likely to receive follow-up care within 30 days.
The study, "Socioeconomic Disparities in Concussion Presentation," was published in the April 2026 issue of JAMA Network Open and conducted in collaboration with ICES, the CHEO Research Institute, and the Children's Hospital of Philadelphia (CHOP).
Mapping the Gaps: Where Ontarians Seek Concussion Care
Drawing on a population-based cohort of 674,629 Ontarians diagnosed with concussion over a 13-year period, the study examined how socioeconomic factors shape where patients first seek care and whether they receive timely follow-up. Overall, 41 per cent of patients first sought care in an ED.
Patients who went to an ED first were more likely to live in lower-income neighbourhoods with fewer material resources, reside in rural communities, and not have a family doctor. Patients from more diverse neighbourhoods were less likely to seek initial care in EDs across all age groups.
Follow-up rates told a similarly concerning story. Patients who first visited an ED were far less likely to complete a follow-up appointment within 30 days compared with those who started in outpatient settings, with the gap widest among adults. Patients without a family doctor faced particularly significant barriers to receiving follow-up care.
When Access Shapes Outcomes
Emergency departments, while essential for urgent care, are often not the optimal setting for concussion management. Most concussions can and should be managed in outpatient settings, where continuity of care and timely follow-up are more readily available. When socioeconomic circumstances determine where a patient first seeks care, those same circumstances can shape the quality and continuity of the care they receive.
"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 the ED is oftentimes the least optimal setting to deliver ideal concussion care," said 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 member of the TRANSCENDENT research team.
"The findings highlight the very real need for system-wide improvements in concussion management, particularly for communities facing socioeconomic marginalization. Improving access to primary care for all patients is critical to providing optimal concussion care, as is developing tools to support ED clinicians and alternative care models, such as telemedicine or remote monitoring."
Building a More Equitable Path to Recovery
The study points to several areas where health care system investment is needed: expanding primary care access, equipping ED clinicians with better tools and resources, and developing alternative care pathways such as telemedicine and remote monitoring. These approaches have the potential to improve access, follow-up, and recovery outcomes for patients who face the greatest barriers to care.
The TRANSCENDENT team is actively evaluating these innovations as part of its broader mission to improve concussion care across the lifespan, particularly for underserved communities.
TRANSCENDENT (Transforming Research by Assessing Neuroinformatics Across the Spectrum of Concussion by Embedding Interdisciplinary Data-Collection to Enable Novel Treatments) is an Integrated Discovery Program funded by the Ontario Brain Institute and led out of the CHEO Research Institute. The program brings together researchers, clinicians, and patient partners to generate real-world evidence on concussion across the lifespan, with a focus on improving care pathways and health equity.