58 - Prevalence of Mild Traumatic Brain Injury in Early Childhood

Poster Number: 58
Publication Number: 58.104

Deborah A. Levine, Weill Cornell Medical College - New York, NY, Port Washington, NY, United States; Sean C. Rose, Nationwide Children's Hospital, Columbus, OH, United States; Junxin Shi, Nationwide Children's Hospital, Columbus, OH, United States; Krista K. Wheeler, Nationwide Children's Hospital, Columbus, OH, United States; Rachel Stanley, Nationwide Childrens Hospital, columbus, OH, United States; Miriam Beauchamp, University of Montreal, Montréal, PQ, Canada

Background: Mild traumatic brain injury (mTBI) or concussion accounts for millions of healthcare visits to Emergency Departments. Much of the current scientific literature focuses on the effects of these injuries in school aged children and sports-related injuries. However, mTBI in the early childhood age period (0-6 years) are common and increasing in prevalence. Injuries in this age group pose diagnostic challenges and can affect functioning in a range of domains but are poorly described.

Objective: To better understand their occurrence, we describe prevalence rates of mTBI in early childhood from a national sample of emergency department (ED) visits.

Design/Methods: The Nationwide Emergency Department Sample (NEDS) was queried for pediatric patients aged < 7 years with mTBI from 2016-2018. Patients were excluded if they were diagnosed with abuse or drowning, died in the ED or hospital, had an injury severity score of >15, or CPT codes for neurosurgical intervention, intubation, or blood product transfusion.

Results: National estimates included 1,069,453 patients. Most injured patients were 0-2 years old (64%) and male (58%). Seventy-two percent of children suffered head injury due to a fall. Most children were evaluated in areas populated by >1 million people (53%) and in non-children’s hospitals (91%). More than half of patients utilized Medicaid (55%) or lived in a zip code with < 50% median household income (59%). More than 83% were diagnosed with unspecified injury of head, with 75% of those receiving CPT codes of low to moderate complexity of medical decision making. As age increased, the unspecified injury of head diagnosis was used less often, in favor of a concussion diagnosis. Overall, 99% of patients were discharged from the ED. Computed Tomography scan of the head was performed in 20% of patients.Conclusion(s): Early childhood mTBI is prevalent in the US. Many of these children are infants or toddlers, injured due to falls, and are treated largely in non-children’s hospitals. The most common diagnostic code associated with these injuries is unspecified injury of head. This information can guide future education and research in early childhood mTBI.