Evidence map›Paper›PMID 37176749›Full record

ReviewJournal of clinical medicine2023

Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective.

John K Yue, Nishanth Krishnan, John P Andrews, Alexa M Semonche, Hansen Deng, Alexander A Aabedi, Albert S Wang, David J Caldwell, Christine Park, Melessa Hirschhorn and 3 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. Article
  3. Observational
  4. Pediatric emergency care: Determinants and systematic barriers.World journal of clinical pediatrics · 2025
    Review
  5. Article
  6. Global emergency medicine: A scoping review of the literature from 2023.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025
    Article
  7. Observational
  8. Article
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

John K YueDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.ORCID 0000-0001-9694-7722
Nishanth KrishnanDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
John P AndrewsDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
Alexa M SemoncheDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
Hansen DengDepartment of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Alexander A AabediDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
Albert S WangDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
David J CaldwellDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
Christine ParkDepartment of Neurosurgery, Duke University, Durham, NC 27708, USA.
Melessa HirschhornDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
Kristen T GhoussainiDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.
Taemin OhDepartment of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA.
Peter P SunDepartment of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMild traumatic brain injury (MTBI) causes morbidity and disability worldwide. Pediatric patients are uniquely vulnerable due to developmental and psychosocial factors. Reduced healthcare access in rural/underserved communities impair management and outcome. A knowledge update relevant to current gaps in care is critically needed to develop targeted solutions.

methodsThe National Library of Medicine PubMed database was queried using comprehensive search terms (("mild traumatic brain injury" or "concussion") and ("rural" or "low-income" or "underserved") and ("pediatric" or "child/children")) in the title, abstract, and Medical Subject Headings through December 2022. Fifteen articles on rural/underserved pediatric MTBI/concussion not covered in prior reviews were examined and organized into four topical categories: epidemiology, care practices, socioeconomic factors, and telehealth.

resultsIncidences are higher for Individuals in rural regions, minorities, and those aged 0-4 years compared to their counterparts, and are increasing over time. Rural healthcare utilization rates generally exceed urban rates, and favor emergency departments (vs. primary care) for initial injury assessment. Management guidelines require customization to resource-constrained settings for implementation and adoption. Decreased community recognition of the seriousness of injury is a consensus challenge to care provision by clinicians. Low parental education and income were correlated with decreased MTBI knowledge and worse outcome. Telehealth protocols for triage/consultation and rehabilitation were feasible in improving care delivery to rural and remote settings.

conclusionsPediatric MTBI/concussion patients in rural/underserved regions experience increased risks of injury, geographic and financial healthcare barriers, and poorer outcomes. Globally, under-reporting of injury has hindered epidemiological understanding. Ongoing MTBI education should be implemented for rural caregivers, schools, and low-income populations to improve community awareness. Telehealth can improve care delivery across acuity settings, and warrants judicious inclusion in triage and treatment protocols.

Indexed as

brain concussionepidemiologyevidence-based practicehealthcare disparitiesmedically underserved areamild traumatic brain injurypediatricrural healthsocioeconomic factorstelemedicine

Identifiers

PMID37176749
PMCPMC10179657

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.