Concussion in Children: Factors Affecting Follow-Up Care

| By Dr. Jennifer Hunnicutt

Factors that Affect Follow-Up Care after a Concussion in Children and Adolescents

In recent years, much recognition and progress has been made in concussion care and management. After sustaining a concussion, seeking follow-up care from qualified healthcare providers is very important. In sport, current guidelines in Canada and the U.S. recommend that athletes who sustain a concussion follow-up to obtain medical clearance prior to returning to sport.

However, despite these guidelines and increased recognition of concussions, there is still concern about individuals seeking appropriate follow-up care.

Today on the blog, we are highlighting a new research study published in 2023 that focuses on follow-up care after concussion, specifically in children and adolescents.

A Research Study on Follow-Up Care After Concussion

Researchers from Alberta, Canada sought to determine factors associated with follow-up care after concussion in children and adolescents.

They conducted a population-based research study across the entire province of Alberta. They linked several healthcare databases to study individuals <18 years who received publicly-funded healthcare for head-related injuries and concussions.

Their study was longitudinal, meaning they studied these individuals over time from the years 2004-2018. This study was also very large – it included 162,982 unique individuals who received medical care for head injury.

Factors that Affect Follow-Up Care after Concussion

Of all episodes of care for head-related injuries, only 13% of individuals received follow-up care. For those specifically with a concussion diagnosis, only 19% of individuals received follow-up care.

The main findings were that follow-up care for concussions increased over time and were more common in males, older adolescents, and those with prior concussion. Follow-up care also was affected by where a patient lives and where they first sought concussion care.

Let’s discuss some of these findings in more detail below:

Patient Age and Sex

Males were more likely to seek follow-up care compared to females. This is likely due to males participating in more contact sports and more risky behaviors. Researchers suggest that there may be a referral bias at play, meaning that healthcare providers are more likely to refer males for follow-up.

Older adolescents were also more likely to receive follow-up care. This is likely due to older adolescents participating more in activities, like sport, that could cause concussion. With medical clearance being required to return to sport, older adolescents were more likely to seek follow-up care.

Where a Patient Lives

Follow-up care for concussion was less common in remote areas and areas of lower socioeconomic status (SES) in Alberta. This is interesting because Canada offers universal healthcare, yet there were still issues with access to care in these areas. The researchers acknowledge that more research is needed to uncover these disparities and focus on increasing access to care in these areas.

Where a Patient First Sought Concussion Care

Patients who visited a physician office for their initial visit were more likely to receive follow-care than when they visited the emergency room. This finding aligns with the general recommendation to not visit the emergency room for concussion, unless emergent signs are present (loss of consciousness, convulsions, slurred speech, repeated vomiting, etc.). However, the researchers reference a previous study in which they found individuals of lower SES were more likely to visit the emergency room. This points to another access-to-care issue – there is decreased access to physicians in more rural or lower SES areas, and therefore, less ability for patients to seek follow-up care after concussion in these areas.


This research study highlights factors associated with follow-up care for concussion in children and adolescents. It is important to remember that this study was conducted in Alberta and may not be generalizable to other locations. Yet, the findings provide important insight that can be used to address barriers to access to follow-up care after concussion.

HEADCHECK Health offers resources to manage post-concussion care. Contact us today to learn more!


Wittevrongel K, Barrett O, Hagel BE, Schneider KJ, Johnson DW, Yeates KO, Zwicker JD. Factors associated with follow-up care after pediatric concussion: A longitudinal population-based study in Alberta, Canada. Front Pediatr. 2023 Jan 9;10:1035909. doi: 10.3389/fped.2022.1035909. PMID: 36699293; PMCID: PMC9869116.

Dr. Jennifer Hunnicutt

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