Who Are the Participants in Pediatric Concussion Randomized Controlled Trials? A Meta-epidemiology Study

OBJECTIVE: To determine if participant race, ethnicity, sex, and gender in pediatric concussion randomized controlled trials (RCTs) equitably represented the demographics of the US general population. DESIGN: Meta-epidemiology study. Data sources included PubMed, Web of Science, PsycInfo, PEDro, Cochrane Library, CINAHL, and RehabData. LITERATURE SEARCH: Included articles were published within 10 years of the search date (2012-2022), were original research, enrolled participants with concussion, and had a mean or median age between 5 and 18 years. RESULTS: The search identified 445 records for screening; we included 43 pediatric concussion RCTs prospectively enrolling 3061 participants. Sex was reported in 42 articles (98%), with 48% described as female participants (range: 0.0% to 75.0%). Gender was not reported in any article. Race and ethnicity were reported in 18 (42%) and 13 articles (30%), respectively. White participants comprised 81.1% of enrolled participants in studies conducted in the United States despite representing 64.2% of the general US population, an over-enrollment rate of 16.9%. Black/African American participants were under-enrolled by 10.1% (3.7% vs 13.8%) and Hispanic/Latino participants by 17.3% (7.9% vs 25.2%). CONCLUSION: Inadequate reporting and inequitable participation of diverse populations persists in pediatric concussion RCTs. JOSPT Open 2025;3(4):1-14. Epub 25 April 2025. doi:10.2519/josptopen.2025.0112