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Citation
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Meyer EJ, Correa ET, Monuteaux MC, Mannix R, Hatoun J, Vernacchio L, Lyons TW. Acad. Pediatr. 2023; ePub(ePub): ePub. |
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Abstract
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OBJECTIVES: To characterize types, duration and intensity of healthcare utilization following pediatric concussion and to identify risk factors for increased post-concussion utilization.
METHODS: A retrospective cohort study of children 5-17 years old diagnosed with acute concussion at a quaternary center pediatric emergency department or network of associated primary care clinics. Index concussion visits were identified using ICD-10-CM codes. We analyzed patterns of healthcare visits six months before and after the index visit using interrupted time-series analyses. The primary outcome was prolonged concussion-related utilization, defined as having ≥1 follow-up visits with a concussion diagnosis more than 28 days after the index visit. We used logistic regressions to identify predictors of prolonged concussion-related utilization.
RESULTS: 819 index visits (median [IQR] age, 14 [11-16] years; 395 (48.2%) female) were included. There was a spike in utilization during the first 28 days after the index visit compared to the pre-injury period. Premorbid headache/migraine disorder (aOR 2.05, 95% CI 1.09 - 3.89) and top quartile pre-injury utilization (aOR 1.90, 95% CI 1.02 - 3.52) predicted prolonged concussion-related utilization. Premorbid depression/anxiety (aOR 1.55, 95% CI 1.31 - 1.83) and top quartile pre-injury utilization (aOR 2.29, 95% CI 1.95 - 2.69) predicted increased utilization intensity.
CONCLUSIONS: Healthcare utilization is increased during the first 28 days after pediatric concussion. Children with premorbid headache/migraine disorders, premorbid depression/anxiety, and high baseline utilization are more likely to have increased post-injury healthcare utilization. This study will inform patient-centered treatment but may be limited by incomplete capture of post-injury utilization and generalizability.
Language: en |