Annual Trends in Follow-Up Visits for Pediatric Concussion in Emergency Departments and Physicians' Offices - 22/11/17

Doi : 10.1016/j.jpeds.2017.09.018

Liraz Fridman, PhD ^1,^* , Michal Scolnik, MSc ², Alison Macpherson, PhD ^1,³, Linda Rothman, PhD ¹, Astrid Guttmann, MDCM, MSc, FRCPC ^3,⁴, Anne M. Grool, MD, PhD ⁵, Daniel Rodriguez Duque, MMath ³, Roger L. Zemek, MD ^5,⁶
¹ York University, Toronto, Ontario, Canada
² Technion American Medical School, Haifa, Israel
³ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
⁴ Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
⁵ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
⁶ Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada

^*Reprint requests: Liraz Fridman, PhD, 4700 Keele St, Toronto, ON M3J1P3, Canada.4700 Keele StTorontoONM3J1P3Canada

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Abstract

Objective

To assess whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines.

Study design

We conducted a retrospective, population-based study using linked health administrative data from all concussion-related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00-18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow-up. The Mann-Kendall test for trends was used to assess a monotonic increasing trend over time in concussion follow-up visits.

Results

A total of 126 654 children and youth were evaluated for an index concussion visit. The number of children and youth assessed for concussion follow-up (N = 45 155) has increased significantly over time (P < .001). In 2003, 781 of 7126 patients (11.0%; 95% CI, 10.3-11.7) with an index visit for concussion had a follow-up assessment. By 2013, 6526 of 21 681 (30.1%; 95% CI, 29.5-30.7) patients received follow-up care.

Conclusions

The proportion of children and youth receiving follow-up after an acute concussion has significantly increased between 2003 and 2013. Nevertheless, more than two-thirds of all patients do not seek medical follow-up or clearance as recommended by current concussion guidelines, suggesting that ongoing efforts to improve and monitor compliance with recommended guidelines by patients and physicians are important.

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Keywords : traumatic brain injury, healthcare use

Abbreviations : ED, ICD-10-CA, OHIP

Plan

Methods

Statistical Analyses

Results

Trends in Annual Concussion-Related Follow-Up Visits

Discussion

Supported by the Ontario Child Health SPOR Support Unit (OCHSU) and the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). A.M. and A.G. are supported by Canadian Institutes of Health Research (CIHR) Chairs in Reproductive and Child Health Services and Policy Research (#126341). R.Z. is supported by a Clinical Research Chair in Pediatric Concussion by the University of Ottawa. The other authors declare no conflicts of interest.