Researchers have discovered a significant gap in U.S. tracking methods for childhood concussions, and current records may be vastly underestimating these injuries, according to a new study by The Children’s Hospital of Philadelphia (CHOP) and the Centers for Disease Control and Prevention (CDC).
The researchers highlight that many current counts of pediatric concussions are based solely on emergency department (ED) visits or on organized high school and college athletics data. However, among 0- to 17-year-olds in the study who were diagnosed with a concussion, only 12 percent had their first visit at the ED.
Furthermore, about one-third of the children were under 12, and would therefore not be included in any high school sports data.
In fact, the researchers found that a vast majority (82 percent) of pediatric concussion patients were first treated at a primary care site. Another 5 percent were treated within a specialty care center (sports medicine, neurology, trauma), and 1 percent were directly admitted to the hospital.
“We learned two really important things about pediatric concussion health care practices,” said 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 diverse 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.”
For the study, researchers analyzed more than 8,000 concussion diagnoses over a recent four-year period (July 2010 – June 2014) among children up to 17 years who receive their primary care within the CHOP network. Over the course of that period, primary care visits as the point of entry increased 13 percent, with a corresponding 16 percent decrease in point-of-entry ED visits.
“This study provides direction for healthcare networks and clinicians about the critical importance of providing targeted training and resources in primary care settings,” said 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.”
Also, compared to more specialized settings, a primary care practice can see injured patients sooner, thus getting them on the proper path for treatment more quickly. With pediatric concussions, the key to recovery is early diagnosis and treatment, including early cognitive and physical rest, followed by close supervision at home.
Using this approach, the majority of concussions will heal within a few weeks. Patients with lingering symptoms or other comorbidities can be referred for specialist care.
“We need surveillance that better captures concussions that occur in children and adolescents,” said Debra Houry, M.D., M.P.H., director of CDC’s 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.”
The findings are published in the journal JAMA Pediatrics.