While focused on head trauma, study findings have larger implications about barriers in healthcare system navigation for all pediatric patients, inspiring new solutions to elevate care across all clinical entry points
PHILADELPHIA, March 25, 2026 /PRNewswire/ -- Researchers at Children's Hospital of Philadelphia (CHOP) found escalating disparities at each point along the healthcare system journey for pediatric head trauma patients from diagnosis through recovery, a "leaky pipeline" of follow up care suggestive of multiple barriers experienced by patients and their families. This important finding is likely applicable to a wide range of pediatric conditions. The study was published today in the Journal of Pediatrics.
In this study, the researchers utilized CHOP's Minds Matter Registry, the largest pediatric concussion registry in the U.S. and unique in its broad scope, which includes data from tens of thousands of pediatric head trauma patients seen across diverse points of entry into the CHOP healthcare system. Researchers evaluated disparities by age, sex, race, ethnicity, insurance status and a composite measure of opportunity, the Child Opportunity Index (COI), 3.0 version. The COI includes 44 indicators important to the health and development of children, with a composite score scaled from 0 (least opportunity) to 100 (most opportunity). The study evaluated three critical junctures in the healthcare system journey of head trauma patients seen in emergency departments (EDs): concussion diagnosis, referral to specialty care, and attendance at specialty care appointments.
"It's important that every pediatric patient with head trauma, no matter how, where, or when they first interact with the healthcare system, receives care that aligns with our best-practice evidence," said study lead author Daniel J. Corwin, MD, MSCE, director of clinical and translational research in the Division of Emergency Medicine and associate director of the Minds Matter Concussion Program at CHOP. "By understanding where patients might fall away from the optimal care journey, we can develop strategies that ensure no patient is left behind."
Among 22,344 patients in the study, 5,998 were diagnosed with concussion, 1,142 of whom were referred to specialty care; of those, 504 attended a specialty visit. Across the three critical junctures of care, there was a stepwise change in age (median 7.0 years old overall sample vs. 12.0 diagnosed with concussion vs. 13.0 referred to specialty care vs. 14.0 attending a specialty visit), race/ethnicity (% identifying as non-Hispanic White 33% vs. 40% vs. 43% vs. 48%), insurance status (% possessing private insurance 46% vs. 53% vs. 56% vs. 61%), and overall COI (median 40 vs. 55 vs. 63 vs.74).
"This work, identifying a 'leaky pipeline' for pediatric head injury, is relevant and applicable to a wide range of pediatric conditions," said co-author Tyra Bryant-Stephens, MD, CHOP Associate Vice President and Chief Health Equity Officer. "We can apply our findings from this study of concussion to help guide interventions to achieve health equity across multiple conditions."
Importantly, the team in the Minds Matter Concussion Program has already begun harnessing this data to guide targeted solutions across two large studies. In the first, they are evaluating the impact of an electronic health record (EHR)-embedded decision support tool to standardize concussion diagnosis and risk stratification for frontline pediatricians. In the second, they are evaluating a novel patient management tool to increase healthcare system engagement for pediatric patients and their families to identify in real-time when they might be encountering issues with recovery and report those issues remotely outside of a doctor's office. The implementation of these multimodal approaches has significant potential to help improve the disparities uncovered in the current manuscript.
This study was supported by the Centers for Disease Control and Prevention Grant U01CE003479-01-00 and National Institute of Neurological Disorders and Stroke of the National Institutes of Health award number K23NS128275-01.
Corwin et al, "The Leaky Pipeline of Injury: Disparities at multiple junctures for children with head trauma." J Pediatr. Online March 20, 2026. DOI: 10.1016/j.jpeds.2026.115066.
About Children's Hospital of Philadelphia:
A non-profit, charitable organization, Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey. CHOP also operates the Middleman Family Pavilion and its dedicated pediatric emergency department in King of Prussia, the Behavioral Health and Crisis Center (including a 24/7 Crisis Response Center) and the Center for Advanced Behavioral Healthcare, a mental health outpatient facility. Its unique family-centered care and public service programs have brought Children's Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit https://www.chop.edu.
Contact: Ben Leach
Children's Hospital of Philadelphia
(609) 634-7906
leachb@chop.edu
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SOURCE Children's Hospital of Philadelphia
