Citation

Zogg CK, Haring RS, Xu L, Canner JK, Ottesen TD, Salim A, Haider AH, Schneider EB. Epidemiology 2018; 29(6): 885-894.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/EDE.0000000000000900

PMID

30063541

Abstract

BACKGROUND: While deaths, hospitalizations, and emergency department visits for head trauma are well understood, little is known about presentations in outpatient settings. Our objective was to examine the epidemiology and extent of healthcare-seeking adult (18-64y) head trauma patients presenting in outpatient settings compared to patients receiving non-hospitalized emergency department care.

METHODS: We used 2004-2013 MarketScan Medicaid/commercial claims to identify head trauma patients managed in outpatient settings (primary care provider, urgent care) and the emergency department. We examined differences in demographic and injury-specific factors, CDC-defined head trauma diagnoses, and extent of and reasons for post-index visit ambulatory care use within 30/90/180 days by index visit location as well as annual and monthly variation in head trauma trends. We used outpatient incidence rates to estimate the US nationwide outpatient burden.

RESULTS: A total of 1.19 million index outpatient visits were included (emergency department: 348,659). Nationwide, they represented a weighted annual burden of 1.16 million index outpatient cases. These encompassed 46% of all known healthcare-seeking head trauma in 2013 (outpatient/emergency department/inpatient/fatalities) and increased in magnitude (+31%) from 2004-2013. One-fourth (27%) of office/clinic visits led to diagnosis with concussion on index presentation (urgent care: 32%). Distributions of demographic factors varied with index visit location, while injury-specific factors were largely comparable. Subsequent visits reflected high demand for follow-up treatment, increased concussive diagnoses, and sequelae-associated care.

CONCLUSIONS: Adult outpatient presentations of head trauma remain poorly understood. The results of this study demonstrate the extensive magnitude of their occurrence and close association with need for follow-up care.

Language: en