Diagnosis and acute management of patients with concussion at children's hospitals
Jeffrey D Colvin1, Cary Thurm, Brian M Pate
1Department of Pediatrics, Division of Pediatric Hospital Medicine, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City, , Kansas City, Missouri, USA.
Insights
Pediatric emergency department visits for concussion increased significantly, but hospital admissions remained stable. Most patients received CT scans and medications, with imaging increasing costs.
Area of Science:
- Pediatric Emergency Medicine
- Neuroscience
- Health Services Research
Background:
- Concussion is a common pediatric injury.
- Understanding trends in diagnosis and treatment is crucial for resource allocation and patient care.
Purpose of the Study:
- To analyze trends in pediatric concussion hospital admissions and emergency department (ED) visits in the USA.
- To describe the utilization of imaging and medications in acute pediatric concussion cases.
Main Methods:
- A cross-sectional study analyzing data from children's hospitals in the Pediatric Health Information System (USA) over a 10-year period.
- Included were all emergency department (ED) visits and inpatient admissions with a primary diagnosis of concussion.
- Key outcomes measured were hospitalization rates, imaging use, medication administration, and associated costs.
Main Results:
- Emergency department (ED) visits for concussion more than doubled between 2001 and 2010, while hospital admissions remained stable.
- Nearly 60% of ED concussion visits involved CT scans, and over 47% received medications or intravenous fluids.
- Costs were significantly higher for visits including imaging, though CT scans in the ED were less expensive than hospitalizations without CT.
Conclusions:
- Despite rising ED diagnoses, pediatric concussion hospital admission rates have not increased.
- CT imaging and medication are frequently administered to pediatric concussion patients in US hospitals.
- The study highlights patterns in diagnostic imaging and treatment for pediatric concussions, with implications for healthcare costs.
Objectives:
To describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients.
Design:
Cross-sectional study.
Setting:
Children's hospitals participating in the Pediatric Health Information System in the USA during a 10-year period.
Patients:
All emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion.
Main Outcome Measures:
The proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion.
Results:
The number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US$695, IQR US$472-$1009, vs US$191, IQR US$114-$287). An ED visit with CT, however, cost less than a hospitalisation without CT (US$1907, IQR US$1292-$3770).
Conclusions:
Although the number of ED patients diagnosed with concussion has increased, the number admitted has remained stable. Concussion patients at paediatric hospitals in the USA commonly undergo CT imaging and receive medication.
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care