Pediatric Mild Traumatic Brain Injury In Maryland: Associations With Early Return To The Emergency Department
Eva Seligman1, Usman Aslam2, *Isam Nasr3
1Johns Hopkins University School of Medicine, Baltimore, MD;2New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY;3Johns Hopkins University School of Medicine, BALTIMORE, MD
Background:Pediatric mild traumatic brain injury (mTBI) requires coordinated, longitudinal care across the spectrum of the emergency department (ED), primary care provider, and mTBI specialist. We examined rates of return visits to the ED after initial mTBI and identified characteristics associated with early ED return.
Methods: Children ≤19 years presenting to Maryland EDs from 2012-2017 were identified using the Maryland Health Services Cost Review Commission database. Unique patients with initial and return mTBI-related encounters were defined using ICD9/10 codes. Return visits included codes for headache and post-concussion syndrome. Patient and injury characteristics were compared using chi-squared testing. Multiple logistic regression was performed to calculate odds ratios for relevant exposures.
Findings: We identified 25,619 initial ED mTBI encounters: 468 (2%) returned within 1 week and 717 (3%) within 1 month for mTBI-related complaints. Early return was associated with older age, female sex, white race, public insurance, sports-related injuries, and lack of head CT obtained at initial visit (Table 1). In multiple regression analysis, public insurance was associated with increased odds of return to the ED within 4 weeks (OR 1.77, CI: 1.65-1.90, p < 0.001).
Conclusions: Early return to the ED for mTBI-related complaints is uncommon. Publicly-insured individuals may be at increased risk for ED return, and targeted study of this group may reveal areas to improve access to appropriate longitudinal mTBI care.
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