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Characterizing Hospitalizations for Pediatric Concussion and Trends in Care
Tara Rhine1,2, Terri Byczkowski3,2, Mekibib Altaye3,4
1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. tara.rhine@cchmc.org.
Insights
Hospitalized children with concussion may face prolonged symptoms. This study analyzed care practices and outcomes for over 10,000 pediatric concussion admissions, finding factors linked to longer stays and readmissions.
Area of Science:
- Pediatric emergency medicine
- Neurotrauma
- Healthcare quality improvement
Background:
- Hospitalized children with concussion are a vulnerable subset with poorly understood outcomes.
- Little is known about the specific care practices and risk factors for prolonged symptoms in this population.
Purpose of the Study:
- To define a cohort of children hospitalized for concussion.
- To describe care practices, identify factors associated with prolonged length of stay (LOS) or emergency department (ED) readmission, and analyze changes in care over time.
Main Methods:
- Retrospective analysis of data from 40 pediatric hospitals (2007-2014).
- Inclusion of children aged 0-17 years with a primary concussion diagnosis.
- Statistical methods included descriptive statistics, logistic regression, and trend analyses.
Main Results:
- Over 10,000 children were admitted for concussion; 68.7% received IV pain/antiemetic medications.
- Female sex, adolescent age, and government insurance were linked to increased odds of LOS ≥2 days and ED revisit.
- Use of IV ondansetron and ketorolac increased, while neuroimaging decreased over time.
Conclusions:
- Hospitalized children with concussion often receive IV therapies with unclear benefits.
- Factors associated with prolonged LOS and ED revisit may predict postconcussive syndrome.
- Prospective studies are needed to establish evidence-based admission criteria and optimize recovery.
Background:
Children hospitalized for concussion may be at a higher risk for persistent symptoms, but little is known about this subset of children.
Objective:
Delineate a cohort of children admitted for concussion, describe care practices received, examine factors associated with prolonged length of stay (LOS) or emergency department (ED) readmission, and investigate changes in care over time.
Design, Setting:
Retrospective analysis of data submitted by 40 pediatric hospitals to the Pediatric Health Information System.
Patients:
Children 0 to 17 years old admitted with a primary diagnosis of concussion from 2007 to 2014.
Measurements:
Descriptive statistics characterized this cohort and care practices delivered, logistic regression identified factors associated with a LOS of =2 days and ED readmission, and trend analyses assessed changes in care over time.
Results:
Of the 10,729 children admitted for concussion, 68.7% received intravenous pain or antiemetic medications. Female sex, adolescent age, and having government insurance were all associated (P = .02) with increased odds of LOS = 2 days and ED revisit. Proportions of children receiving intravenous ondansetron (slope = 1.56, P = .001) and ketorolac (slope = 0.61, P < .001) increased over time, and use of neuroimaging (slope = -1.75, P < .001) decreased.
Conclusions:
Although concussions are usually selflimited, hospitalized children often receive intravenous therapies despite an unclear benefit. Factors associated with prolonged LOS and ED revisit were similar to predictors of postconcussive syndrome. Since there has been an increased use of specific therapeutics, prospective evaluation of their relationship with concussion recovery could lay the groundwork for evidenced-based admission criteria and optimize recovery.
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