190 - Characterization and Predictors of Healthcare Utilization after Pediatric Concussion

Poster Number: 190
Publication Number: 190.319

Erin J. Meyer, Boston Children's Hospital, Boston, MA, United States; John J. Porter, Boston Children's Hospital, Boston, MA, United States; Michael C. Monuteaux, Boston Children's Hospital, Boston, MA, United States; Rebekah Mannix, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Jonathan Hatoun, Harvard Medical School, Boston, MA, United States; Louis Vernacchio, Pediatric Physician's Organization at Children's, Wellesley, MA, United States; Todd Lyons, Boston Children's Hospital, Boston, MA, United States; Emily T. Correa, Boston Children's Hospital, Wellesley, MA, United States

Background: Little is known about healthcare utilization in the critical period following pediatric concussion.

Objective: To characterize the types, intensity and duration of healthcare utilization following pediatric concussion and to identify risk factors for prolonged utilization.

Design/Methods: We conducted a retrospective cohort study using electronic health record data from a large quaternary care pediatric center and network of associated outpatient clinics. Patients were 5-17 years old and diagnosed with an acute concussion or head injury (to increase sensitivity for concussion) in the emergency room or an outpatient primary care clinic (the "index visit") without concomitant hemorrhage or skull fracture. We measured the number and types of healthcare visits six months before and after the index visit. We used interrupted time series analyses to compare utilization in the baseline ‘pre-injury period’, the ‘immediate post-injury period’ (first 28 days after injury), and ‘delayed post-injury period’ (beyond 28 days). A cutoff of 28 days was defined a priori based on literature of post-concussion syndrome. We defined prolonged concussion-related utilization as >1 visit with an assigned diagnosis of concussion >28 days after the index visit. We utilized multivariable logistic regression to identify predictors of prolonged utilization.

Results: A total of 1,254 index visits were included. The median age was 13.0 years (interquartile range 9.7-15.6 years) and 699 (56%) were male. There was an immediate spike in overall utilization rate in the immediate post-injury period, but no difference was found between the delayed post-injury period and the pre-injury period (Figure 1). Most utilization (57%) in the immediate post-injury period was primary care, while most delayed post-injury utilization (83%) was subspecialty care (Figure 2). Ninety-two (5.3%) index visits had subsequent prolonged concussion-related utilization. Receiving a concussion diagnosis (versus a diagnosis of head injury) at the index visit [adjusted OR 4.45, 95% CI 2.05-9.68] and presence of premorbid headaches or migraines at time of diagnosis [adjusted OR 2.25, 95% CI 1.18-4.28] predicted prolonged concussion-related utilization.Conclusion(s): Health care utilization rises rapidly after pediatric concussion but returns nearly to baseline after 28 days. Children diagnosed with concussion at their index visit and those with premorbid headaches are more likely to have prolonged healthcare utilization. These findings will inform patient-centered treatment planning and resource allocation within healthcare systems.
Erin Meyer CVMeyer CV_2021_12_09.pdf
Figure 2Concussion-related utilization (i.e. visits with assigned ICD-10 concussion diagnosis) after the index visit. Each bar represents cumulative weekly visits (the index visits themselves are not included), and the dotted line at day 28 denotes the cutoff for prolonged utilization.