Online Program

Clinical presentation patterns and settings for pediatric traumatic brain injury at one, large midwest children's hospital

Wednesday, November 6, 2013

Christy Collins, Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH
Thomas Pommering, DO, College of Medicine, Department of Pediatrics, The Ohio State University, Westerville, OH
Keith Yeates, PhD, College of Medicine, Department of Pediatrics, The Ohio State University, Columbus, OH
Rebecca Andridge, PhD, College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, OH
R. Dawn Comstock, PhD, Colorado School of Public Health, Aurora, CO
Background: Although many traumatic brain injuries (TBIs) present to emergency departments (EDs), data limited to EDs severely underestimate the incidence of TBI. The objectives were to 1) report the incidence of TBIs across multiple clinical settings in one large, pediatric hospital and 2) investigate potential differences in the diagnosis and management of TBIs by demographic characteristics and clinical setting. Methods: All TBIs sustained by children ≤20 years of age treated at one large Midwest Children's Hospital from August 1, 2010 through July 31, 2011 were identified using ICD-9 codes 310.2, 800-801.9, 803-804.9, 850-854.16, and 959.01. Results: 3,971 individuals ≤20 years of age were seen during 5,429 TBI-related visits. The majority of TBI-related visits were for unspecified head injuries (47.4%) or concussions (40.6%); and 92.0% were classified as mild TBI-related. Although the most common treatment site/setting was ED, it represented only 32.7% of all visits. Clinic outpatient (31.4%) and urgent care (27.6%) were other common settings. A higher proportion of white patients was diagnosed with concussion, had commercial insurance, and had two or more related visits compared to Black/African American patients. Conclusions: This study, the first to describe pediatric TBIs across all clinical settings at one large pediatric hospital, found only one third of pediatric TBI visits were in the ED and 92% of TBIs could be classified as mild. Investigating TBIs across the full spectrum of clinical care is needed to provide both clinicians and policy makers with a better understanding of the true incidence of pediatric TBI.

Learning Areas:

Public health or related research

Learning Objectives:
Explain why it is important to consider visits at all clinical settings when describing the true incidence of pediatric traumatic brain injury Describe the clinical presentation patterns and settings for pediatric traumatic brain injury at one large, pediatric hospital in the Midwest

Keyword(s): Traumatic Brain Injury, Child/Adolescent

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been researching pediatric injuries at the Center for Injury Research and Policy at Nationwide Children's Hospital for over 8 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.