Patterns and Predictors of Health Care Utilization After Pediatric Concussion: A Retrospective Cohort Study
Erin J Meyer1, Emily Trudell Correa2, Michael C Monuteaux1
1Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass.
Insights
Pediatric concussion care utilization spikes in the first 28 days post-injury. Pre-existing headache, migraine, depression, anxiety, and high prior healthcare use predict increased post-concussion utilization.
Area of Science:
- Pediatric neurology
- Healthcare utilization research
- Public health
Background:
- Pediatric concussion is a common injury requiring healthcare.
- Understanding post-concussion healthcare needs is crucial for effective management.
- Identifying factors influencing utilization can optimize care pathways.
Purpose of the Study:
- To characterize health care utilization patterns after pediatric concussion.
- To identify risk factors for increased and prolonged post-concussion healthcare utilization.
Main Methods:
- Retrospective cohort study of children aged 5-17 with acute concussion.
- Analysis of healthcare visits 6 months pre- and post-index concussion diagnosis.
- Interrupted time-series analyses and logistic regressions to identify predictors.
Main Results:
- Healthcare utilization significantly increased within 28 days post-concussion.
- Premorbid headache/migraine and high pre-injury utilization predicted prolonged utilization.
- Premorbid depression/anxiety and high pre-injury utilization predicted increased utilization intensity.
Conclusions:
- Post-concussion healthcare utilization is elevated in the initial 28 days.
- Children with specific pre-existing conditions and high baseline utilization face higher post-injury healthcare demands.
- Findings can inform patient-centered treatment strategies for pediatric concussion.
Objective:
To characterize types, duration, and intensity of health care utilization following pediatric concussion and to identify risk factors for increased post-concussion utilization.
Methods:
A retrospective cohort study of children 5 to 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 International Classification of Diseases, Tenth Revision, Clinical Modification codes. We analyzed patterns of health care visits 6 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:
Eight hundred nineteen index visits (median [interquartile range] 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 (adjusted odds ratio (aOR) 2.05, 95% confidence interval [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:
Health care 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 health care utilization. This study will inform patient-centered treatment but may be limited by incomplete capture of post-injury utilization and generalizability.
