The Care Gap Between Sport-Related and Non-Sport-Related Concussion

Same Injury, Two Systems: Why Non-Sport Concussions Deserve the Same Specialized Care

A high school linebacker takes a hit on Friday night. An athletic trainer pulls him from the field, a documented protocol begins, his parents receive a referral, and he is evaluated at a concussion specialty clinic the following week.

A high school junior falls down the basement stairs on Saturday morning. There is no athletic trainer, no sideline protocol, and no established referral pathway. She waits two days, goes to urgent care, receives a normal head CT and standard discharge instructions, and is told to rest until she feels better.

The injury is the same. The care is not.

Concussion is defined by what happens inside the skull, not by the setting in which it occurred. Yet in practice, the mechanism of injury (sport or non-sport) is one of the strongest predictors of how quickly a patient is identified, how quickly they are referred, and whether they ever reach a clinician trained to treat the injury at all.

Non-sport concussion is the larger problem, not the smaller one

Twenty years of public attention have made sport the face of concussion. The epidemiology tells a more complicated story.

In a multicenter study of pediatric emergency department presentations, non-sport-related concussion accounted for 56.3 percent of all concussions, including 80.9 percent among children ages five to eight and 51.1 percent among children ages nine to twelve. Falls were the most common non-sport mechanism at every age. Sport becomes proportionally more common as children get older, but it never becomes the whole picture. Across the lifespan, concussions also occur through falls, motor vehicle collisions, workplace injuries, assaults, and household accidents, settings that generally lack the infrastructure available to athletes.

That is the core of the disparity.

Sport-related concussion has infrastructure. Non-sport-related concussion often does not.

Organized athletics developed something no other injury setting has: a standing surveillance system

Return-to-play legislation exists in many states. Athletic trainers are embedded at practices and games. Baseline neurocognitive testing is used in many programs. Coaches, officials, and parents receive concussion education. Removal-from-play rules are established. Referral pathways to specialty concussion care are increasingly protocol driven.

An athlete who sustains a concussion during a game may have multiple people immediately watching for symptoms and a system already designed to determine what happens next.

A person who sustains the same injury in a car, at work, or on a staircase often enters no such system. Recognition may depend on the injured person deciding that something is wrong. Referral may depend on whether the first clinician they encounter recognizes the need for specialty concussion care. Follow-up may depend on whether anyone schedules it.

The difference is not necessarily the severity of the initial injury. It is the infrastructure surrounding the patient.

What I see in the clinic, and what the data confirms

The gap is not only administrative. It shows up in the exam room, and it shows up consistently enough that my colleagues and I set out to quantify it.

In a study we published in the American Journal of Physical Medicine & Rehabilitation, we compared the pre-injury and early clinical characteristics of adolescents presenting to a specialty concussion clinic after sport-related versus non-sport-related injury. Our sample included 136 patients ages 10 to 18 who were evaluated within thirty days of injury. Roughly one in four had sustained a non-sport-related concussion.

Those patients looked different on arrival.

Adolescents with non-sport-related concussion were older, more likely to be female, and, critically, presented to the clinic later than their sport-injured peers. They were also more likely to report a pre-injury history of headache or migraine and a pre-injury history of depression.

That combination matters more than it may initially appear.

Delayed presentation, pre-injury migraine, and pre-injury mood history have each been associated with greater risk for prolonged recovery. In other words, the patients who are less likely to reach specialty care quickly may also arrive with characteristics associated with greater recovery risk.

Findings from the NCAA-DoD CARE Consortium point in the same direction among college athletes, a population that generally has access to athletic training resources. Across 3,500 athletes, those injured outside of sport were less likely to report the injury immediately and more likely to show delayed symptom presentation. Their post-injury outcomes were worse than those of athletes with sport-related concussion, and female athletes with non-sport injuries fared worse still.

If this disparity persists even among varsity athletes who may have an athletic trainer available to them, the gap can be even greater for patients who have no athletic system surrounding them.

Where the barriers actually sit

Four barriers do most of the work.

1. Recognition

A concussion sustained during a game is witnessed by people trained to look for it. A concussion sustained in a parking lot, a stairwell, a workplace, or a household accident is often not recognized as a brain injury at all, by the patient or by anyone around them.

Symptoms may be attributed to stress, whiplash, poor sleep, anxiety, or simply having a bad week.

2. Point of entry

Sport-related injury tends to enter healthcare through an athletic trainer, sports medicine practice, or established concussion program.

Non-sport injury often enters through an emergency department or urgent care setting, where the immediate clinical priority is to rule out dangerous structural injury.

That distinction is important. A normal CT is reassuring because it can help rule out certain serious structural injuries. But a normal CT does not evaluate the functional consequences of concussion. It does not determine whether a patient has vestibular dysfunction, visual-motor impairment, exertional intolerance, cognitive symptoms, sleep disturbance, or other problems that may require targeted treatment.

3. Referral

Without an established pathway, referral to specialty concussion care depends heavily on individual clinician awareness. Many patients are told that the injury will resolve on its own.

For most people, symptoms do improve with time. But a substantial minority develop persistent symptoms that may benefit from targeted evaluation and treatment. The challenge is identifying those patients rather than simply waiting for them to get better.

4. Access and follow-through

The disparity does not end when a patient receives a diagnosis. A population-based cohort study of 674,629 patients diagnosed with concussion in Ontario found that neighborhood socioeconomic marginalization, rurality, and the absence of a primary care physician were each associated with a greater likelihood of presenting to an emergency department rather than an outpatient setting. Those same patients were significantly less likely to receive follow-up care within thirty days.

Cost, transportation, time away from work or school, insurance coverage, and language barriers can compound every failure upstream. A patient cannot benefit from specialty care that they cannot access.

What appropriate care actually looks like

Specialty concussion evaluation is not simply a longer version of an emergency department visit.

It answers a different question.

The emergency department asks: Is there an immediately dangerous structural injury that requires emergency intervention?

A concussion-focused evaluation asks: What symptoms and functional systems are affected, and what treatment does this patient need?

The goal is not to order more testing for the sake of testing. The goal is to identify what is impaired so that treatment can be directed toward the problems actually affecting the patient.

Closing the gap

None of this argues for less attention to sport-related concussion. It argues for extending the infrastructure that sport has developed to everyone who sustains a concussion. The standard of care should not depend on whether the injury happened under stadium lights or in a driveway. Practically, that means emergency departments and urgent care centers should have clear discharge pathways that include concussion follow-up and specialty referral when appropriate, not only red-flag return precautions. Primary care providers should know that a normal CT does not conclude the evaluation of a concussion. And patients and families should understand that persistent symptoms following a head injury, whether from a sports collision, fall, motor vehicle crash, workplace incident, or assault, deserve to be taken seriously.

The mechanism may be different. The brain injury is not automatically less important because it happened outside of sport.

If you or someone in your family is still experiencing symptoms more than a few weeks after a head injury of any kind, consider evaluation by a clinician who specializes in concussion care. Recovery is not simply a matter of waiting long enough. It is a matter of identifying what is impaired and determining what can be done to help.

Learn more about concussion evaluation and specialized care at Patel Concussion Institute.

References

1. Rausa VC, Borland ML, Kochar A, et al. Pediatric sport and nonsport concussions presenting to emergency departments: injury circumstances, characteristics, and clinical management. Neurosurg Focus. 2024;57(1):E4. doi:10.3171/2024.4.FOCUS2493

2. Patel S, Zynda AJ, Burley C, et al. Comparison of preinjury and clinical characteristics between adolescents with sport-related concussion and non-sport-related concussion presenting to a specialty concussion clinic. Am J Phys Med Rehabil. 2026;105(5):412-419. doi:10.1097/PHM.0000000000002898

3. Roby PR, Mozel AE, Arbogast KB, et al; CARE Consortium Investigators. Postinjury outcomes after non–sport-related concussion: a CARE Consortium study. J Athl Train. 2024;59(3):289-296. doi:10.4085/1062-6050-0181.23

4. Corwin DJ, Li W, Fung SG, et al; TRANSCENDENT Research Program. Socioeconomic disparities in concussion presentation. JAMA Netw Open. 2026;9(4):e267416. doi:10.1001/jamanetworkopen.2026.7416

5. Kontos AP, Sufrinko A, Sandel N, Emami K, Collins MW. Sport-related concussion clinical profiles: clinical characteristics, targeted treatments, and preliminary evidence. Curr Sports Med Rep. 2019;18(3):82-92. doi:10.1249/JSR.0000000000000573

6. Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport—Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711.

About the author:

Shan Patel, PsyD, is a neuropsychologist and concussion specialist who completed his fellowship through the UPMC Sports Medicine Concussion Program. He is the Owner and CEO of the Patel Concussion Institute (PCI), a telehealth-based practice serving patients nationally via PSYPACT, and serves as Clinical Director of the University Orthopedic Care, Concussion Program, and Integrative Behavioral Health Program, overseeing operations across 14 hospital-based clinics in Florida.