Patterns and Predictors of Health Care Utilization After Pediatric Concussion: A Retrospective Cohort Study

Erin J Meyer; Emily Trudell Correa; Michael C Monuteaux; Rebekah Mannix; Jonathan Hatoun; Louis Vernacchio; Todd W Lyons

doi:10.1016/j.acap.2023.04.010

Patterns and Predictors of Health Care Utilization After Pediatric Concussion: A Retrospective Cohort Study

Acad Pediatr. 2024 Jan-Feb;24(1):51-58. doi: 10.1016/j.acap.2023.04.010. Epub 2023 May 5.

Authors

Erin J Meyer¹, Emily Trudell Correa², Michael C Monuteaux³, Rebekah Mannix³, Jonathan Hatoun⁴, Louis Vernacchio⁴, Todd W Lyons³

Affiliations

¹ Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass. Electronic address: erin.meyer@umassmemorial.org.
² Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass.
³ Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass.
⁴ Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass; Department of Pediatrics (J Hatoun and L Vernacchio), Boston Children's Hospital and Harvard Medical School, Mass.

PMID: 37148968
DOI: 10.1016/j.acap.2023.04.010

Abstract

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.

Keywords: concussion; mild traumatic brain injury; utilization.

MeSH terms

Adolescent
Athletic Injuries* / complications
Athletic Injuries* / diagnosis
Brain Concussion* / diagnosis
Brain Concussion* / etiology
Brain Concussion* / therapy
Child
Child, Preschool
Female
Headache / complications
Humans
Male
Patient Acceptance of Health Care
Retrospective Studies