For a vast majority of children, the first point-of-entry for concussion care is through primary care, and, as such, incidence estimates that are based solely on ED visits underestimate the burden of injury, according to data published in JAMA Pediatrics.
“Concussion diagnosis remains symptom-based and does not require advanced diagnostic tools such as imaging,” Kristy B. Arbogast, PhD, of the Children’s Hospital of Philadelphia (CHOP), in Pennsylvania, and colleagues wrote. “Thus, unlike many other types of traumatic injuries, children with concussion potentially enter the health care system through a variety of portals, including primary care or specialty care, such as sports medicine or neurology, in addition to the emergency department and urgent care.”
To analyze the various points of entry for children with concussion, overall and by factors including age, sex, race/ethnicity and payer, the researchers conducted a descriptive, epidemiologic study, drawing data from 8,083 patients aged 0 to 17 years in primary care, specialty care, ED, urgent care and inpatient settings. The initial concussion-related visit was selected and changes to the original setting were examined in relation to relevant variables.
The main outcome was frequency of initial concussion visit at each type of setting. All patients aged 0 to 17 years who received primary care through the CHOP network, and had one or more in-person visit for concussion in the network’s electronic health record (EHR) system from July 1, 2010, to June 30, 2014, were included in the study.
According to the researchers, 81.9% (95% CI, 81.1-82.8) first sought treatment for their concussion at CHOP through primary care. Meanwhile, 5.2% (95% CI, 4.7-5.7) had their initial visit within specialty care, and 11.7% (95% CI, 11-12.4) had their first point-of-entry within the ED. In addition, 52% of children aged 0 to 4 years entered CHOP for concussion care through the ED, whereas more than 75% of those aged 5 to 17 years entered via primary care. More Medicaid patients used the ED for concussion, 37% vs. 7% of patients with private insurance and 24% of self-pay patients.
“In summary, using a novel method to leverage rich data captured in a unified EHR system on a diverse demographic and socioeconomic population, this study suggests that incidence estimates of pediatric concussion that rely solely on ED records substantially underestimate the true incidence of this injury,” Arbogast and colleagues wrote. “Most pediatric patients with concussion sought their initial concussion care within the CHOP network with a primary care clinician, illustrating the need to provide up-to-date training and clinical decision support tools to these clinicians.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.