Mild Traumatic Brain Injury in Pediatric Patients: Epidemiology, Mechanism of Injury, and Point of Entry into the Maryland Healthcare System
Eva Seligman, MD1; Usman Aslam, MS2; Isam W. Nasr, MD3
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; 2Johns Hopkins University Bloomberg School of Public Health, Selden, NY; 3Johns Hopkins, Baltimore, MD
Background - Mild traumatic brain injury (mTBI) leads to serious neurocognitive deficits within the vulnerable pediatric population, creating a large healthcare burden. The epidemiology of mTBI is difficult to assess since it is under-diagnosed and many databases exclude outpatient encounters. We sought to determine prevalence, characteristics, and healthcare setting of initial evaluation of mTBI in Maryland.
Methods - Children under 19 years presenting to outpatient, emergency, or inpatient settings in Maryland from 2012-2017 were identified using the Maryland Health Services Cost Review Commission database. For each unique patient, initial mTBI-related encounters were defined using ICD9/10 codes. Data were analyzed using descriptive statistics.
Results - We identified 27,539 initial encounters for mTBI in patients <19 years old. The majority were males (60%) and children >5 years old (90%). 57% were privately insured and 33% had public insurance. 25,801 (94%) patients were evaluated in an emergency department then discharged, while 628 (2%) were admitted. 1,102 (4%) were seen as outpatients then discharged. The most common mechanisms of injury were coded: "struck by object" (10,732, 42%), "fall" (9063, 36%), and "motor vehicle accident" (2407, 9%). Only 12% were sport related injuries.
Conclusions - Over 5,000 children in Maryland were evaluated each year for mTBI. Most injuries were due to non-sports-related trauma among school-aged children, many of whom were privately insured. The vast majority of patients were evaluated in the ED and discharged home, thus education and best-practice interventions may be best targeted to those settings to improve the care of mTBI in this at-risk population.
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