A-11 Social Determinants of Health in the Diagnosis and Management of Pediatric Concussion: A Content Analysis

Abstract Purpose: This content analysis examined the literature underlying the Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children (i.e., the “Guideline”) to determine the extent to which social determinants of health (SDH) were examined or addressed. Methods: A published systematic review, that formed the basis for the Guideline, included 37 studies addressing diagnosis, prognosis, and treatment/rehabilitation. We examined those studies to identify SDH domains and associated subcategories derived from the Healthy People 2020 and 2030 websites. Pairs of raters coded each article with disagreements resolved by consensus. Results: At least one SDH domain was represented in 60% of the articles, usually mentioned descriptively, as a covariate, or as a design consideration. Very few were addressed as a primary focus of the study. The most frequently represented SDH domain was Education Access (43.2% of studies), receiving credit most often for reporting on participants with learning disabilities. Social and Community Context, broadly defined, was represented in nearly 1 of 3 studies (29.7%). Economic Stability and Health Care Access domains were included in 6 studies (16.2%). Some studies (k = 6, 16.2%) referenced SDH as important to consider for future research. The Guideline includes some commentary on health literacy and socioeconomic status. Conclusions: Social determinants of health are largely unrepresented as important or meaningful variables influencing the Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children, or in the studies included in the systematic review that informed the guideline.