Concussions Undercounted in Younger Children

The United States is seriously underestimating the number of pediatric concussions, according to research conducted by The Children’s Hospital of Philadelphia (CHOP). Researchers found that among 0 to 17 year olds who have a CHOP primary care physician, 82% had their first concussion visit at a primary care site, 12% at the emergency department, 5% within specialty care and 1% were directly admitted to the hospital.

Many counts of concussion injury among school children are based on emergency room visits. The researchers of this study fear we may be vastly underestimating the number of child and youth concussions that take place in the U.S.

Using the CHOP electronic health record, researchers retrospectively analyzed more than 8, 000 concussion diagnoses among children up to 17 years of age who receive their primary care within the CHOP network. Over the course of that period (July 2010 to June 2014), primary care visits as the point of entry increased 13%, with a corresponding 16% decrease in point-of-entry E.D. visits.

“We learned two really important things about pediatric concussion healthcare practices, ” says Kristy Arbogast, Ph.D., lead author and co-scientific director of CHOP’s Center for Injury Research and Prevention. “First, four in five of this group of children were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems that focus on high school athletes.”

“This study provides direction for healthcare networks and clinicians about the critical importance of providing targeted training and resources in primary care settings, ” says Christina Master, M.D., a co-author and pediatric sports medicine specialist at CHOP. “With targeted training and support, pediatric primary care providers are well-positioned to diagnose and treat the vast majority of concussions.”

Typically, compared to more specialized settings, a primary care practice can see injured patients sooner, thus getting them on the proper path for treatment earlier. “We need surveillance that better captures concussions that occur in children and adolescents, ” says Debra Houry, M.D., M.P.H., and director of Centers for Disease Control’s (CDC) National Center for Injury Prevention and Control. “Better estimates of the number, causes, and outcomes of concussion will allow us to more effectively prevent and treat them, which is a priority area for CDC’s Injury Center.”