Most Children with Concussions Present to Primary Care Settings

May 31, 2016

Most Children with Concussions Present to Primary Care Settings

  1. John D. Cowden, MD, MPH

Data challenge the prevailing view that high school athletes presenting to EDs are the main population for concussion care and research.

  1. John D. Cowden, MD, MPH

As concussion awareness has risen, clinical and research efforts have focused on adolescents in organized sports who present to emergency departments (EDs) or sports medicine clinics. Patterns of presentation for concussion care across a broader age range of youth and across different health care settings are lacking.

An analysis of an integrated electronic health record system from a large pediatric healthcare network (Children's Hospital of Philadelphia) showed that 8083 children aged 0–17 years presented with concussion from 2010 to 2014. Age at initial visit for concussion varied widely (0–4 years, 5%; 5–11 years, 31%; 12–14 years, 35%, and 15–17 years, 30%), and over 80% of patients presented to primary care settings. Only 12% presented to EDs and 5% to specialty clinics (e.g., sports medicine). Patients who were non-Hispanic black, Medicaid-insured, or aged 0–4 years were more likely to present to the ED than to a primary care office.

Comment

Primary care pediatricians typically are not considered key players in the evaluation and care of concussions. This study shows that they should be. Preparation to ensure accurate evaluation and treatment of concussion in all age groups should be a top priority in primary care settings. Individual providers and health systems might use these data to prompt immediate efforts to improve frontline capabilities. (Note: For pediatricians looking for practice guidance in this area, see the following 2014 guideline coverage: NEJM JW Pediatr Adolesc Med Sep 2014).

Editor Disclosures at Time of Publication

  • Disclosures for John D. Cowden, MD, MPH at time of publication Leadership positions in professional societies Co-Chair, Culture, Ethnicity, and Health Care Special Interest Group, Academic Pediatric Association

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