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Published on: August 16, 2019
Emergency department visits for mild traumatic brain injury in early childhood
Sean C Rose1, Deborah A Levine2, Junxin Shi3
1Nationwide Children's Hospital and The Ohio State University College of Medicine, Division of Pediatric Neurology, Columbus, OH 43205, United States.
Insights
Mild traumatic brain injury (mTBI) in young children is common, particularly from falls, leading to significant healthcare costs. Diagnostic coding and imaging practices vary widely across U.S. emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Public Health
Background:
- Early childhood brain injuries can impede neurodevelopment.
- Research on mild traumatic brain injury (mTBI) primarily focuses on school-aged children.
- Limited data exists on mTBI incidence and healthcare use in very young children.
Purpose of the Study:
- To determine the incidence of mTBI in U.S. emergency departments (EDs) for children aged 0-6 years.
- To characterize healthcare utilization patterns for pediatric mTBI.
- To identify demographic and injury-related factors associated with mTBI in young children.
Main Methods:
- Utilized the Nationwide Emergency Department Sample (2016-2019) for children aged 0-6 years with mTBI.
- Excluded severe TBI, drowning, abuse, in-hospital death, high Injury Severity Score, neurosurgery, intubation, or blood transfusion.
- Analyzed patient demographics, injury mechanisms, diagnoses, hospital characteristics, imaging use, and costs.
Main Results:
- Estimated 1,372,291 pediatric mTBI visits; 63.5% were under two years old, 57.5% male, 69.4% from falls.
- Most common diagnosis was "unspecified injury of head," shifting to concussion with age.
- Over 98% discharged from ED; CT scans performed in 18.7% (head) and 1.6% (cervical spine), less frequent at children's hospitals.
Conclusions:
- Early childhood mTBI is frequent, imposing a substantial financial burden on the U.S. healthcare system.
- Significant variability exists in diagnostic coding and CT utilization across EDs.
- Further research is essential to establish optimal diagnostic and management protocols for pediatric mTBI.
Background:
Brain injury during early childhood may disrupt key periods of neurodevelopment. Most research regarding mild traumatic brain injury (mTBI) has focused on school-age children. We sought to characterize the incidence and healthcare utilization for mTBI in young children presenting to U.S. emergency departments (ED).
Methods:
The Nationwide Emergency Department Sample was queried for children age 0-6 years with mTBI from 2016 to 2019. Patients were excluded for focal or diffuse TBI, drowning or abuse mechanism, death in the ED or hospital, Injury Severity Score > 15, neurosurgical intervention, intubation, or blood product transfusion.
Results:
National estimates included 1,372,291 patient visits: 63.5% were two years or younger, 57.5% were male, and 69.4% were injured in falls. The most common head injury diagnosis was "unspecified injury of head" (83%); this diagnosis decreased in frequency as age increased, in favor of a concussion diagnosis. Most patients were seen at low pediatric volume EDs (64.5%) and non-children's hospital EDs (86.2%), and 64.9% were seen at a non-teaching hospital. Over 98% were treated in the ED and discharged home. Computed tomography of the head and cervical spine were performed in 18.7% and 1.6% of patients, respectively, less often at children's hospitals (OR = 0.55, 95%CI = 0.41-0.76 for head and OR = 0.19, 95%CI = 0.11-0.34 for cervical spine). ED charges resulted in $540-681 million annually, and more than half of patients utilized Medicaid.
Conclusions:
Early childhood mTBI is prevalent and results in high financial burden in the U.S. There is wide variation in diagnostic coding and computed tomography scanning amongst EDs. More focused research is needed to identify optimal diagnostic tools and management strategies.
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