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A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Factors associated with follow-up care after pediatric concussion: A longitudinal population-based study in Alberta,
Krystle Wittevrongel1, Olesya Barrett2, Brent E Hagel3,4,5,6,7
1School of Public Policy, University of Calgary, Calgary, AB, Canada.
Insights
Pediatric concussion follow-up care increased over time. Factors like age, sex, SES, and prior concussion history influence care access for children and adolescents.
Area of Science:
- Pediatric neurology and public health research.
- Analysis of healthcare administrative data for injury management.
Background:
- Concussion is a prevalent injury in children and adolescents.
- Current guidelines emphasize supervised recovery through follow-up visits.
- Understanding factors influencing follow-up care is crucial for evidence-based practice.
Purpose of the Study:
- To identify predisposing, enabling, and need-based factors associated with follow-up care after pediatric concussion.
- To inform strategies for improving adherence to concussion recovery guidelines.
Main Methods:
- Retrospective population-based cohort study using administrative health data in Alberta, Canada (2004-2018).
- Analysis of 194,081 episodes of care (EOC) for patients under 18 with concussion-related diagnoses.
- Logistic regression models used to assess associations between patient/visit characteristics and follow-up care receipt.
Main Results:
- Only 13% of EOCs involved follow-up care.
- Males and adolescents were more likely to receive follow-up care.
- Follow-up care was less likely in remote areas or lower socioeconomic status (SES) communities, but increased from 2011 onwards.
- Outpatient EOCs, multiple EOCs, and concussion diagnoses were associated with higher follow-up rates.
Conclusions:
- Follow-up care for pediatric concussion has increased but remains suboptimal.
- Care is associated with patient demographics, socioeconomic factors, geographic location, and injury characteristics.
- Understanding these factors is key to aligning clinical practice with recommended follow-up guidelines for pediatric concussion.
Background:
Concussion is a common injury in children and adolescents. Current best practice guidelines indicate that recovery should be supervised through recurrent follow-up visits. A more detailed understanding of the system-level and individual factors that are associated with follow-up care is a critical step towards increasing evidence-based practice. The objective of this study was to identify predisposing, enabling, and need-based factors associated with follow-up care after pediatric concussion.
Materials And Methods:
A retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients <18 years of age with a diagnosis of concussion, other specified injuries of the head, unspecified injury of head, or post-concussion syndrome (PCS) between April 1, 2004 and March 31, 2018 in Alberta, Canada. The association between predisposing, enabling, and need-based factors and the receipt of follow-up care within a defined episode of care (EOC) was analyzed using logistic regression models for the entire cohort and for EOC that began with a concussion diagnosis. Predisposing factors included age and sex. Enabling factors included the community type of patient residence, area-based socioeconomic status (SES), and visit year. Need-based factors included where the EOC began (outpatient vs. emergency settings) and history of previous concussion-related EOC.
Results:
194,081 EOCs occurred during the study period but only 13% involved follow-up care (n = 25,461). Males and adolescents were more likely to receive follow-up care. Follow-up was less likely among patients who lived in remote communities or in areas of lower SES, while EOCs beginning in 2011 or later were more likely to involve follow-up care. Patients whose EOC began in outpatient settings, had more than one EOC, or a diagnosis of concussion were more likely to receive follow-up care.
Conclusion:
Follow-up care for pediatric concussion has increased over time and is associated with patient age and sex, history of concussion-related EOC, where a patient lives (community type and area-based SES), and when and where the index visit occurs. A better understanding of which children are more likely to receive follow-up care, as well as how and when they do, is an important step in aligning practice with follow-up guidelines.
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