Novel Use of Electronic Health Records to Quantify Patterns of Health Care Utilization for Pediatric Concussion

Background: Previous epidemiologic research on concussions has been limited by population (e.g., athletes) or site of healthcare delivery (e.g., emergency department (ED)). However, only half of concussions occur from sports, and children with concussions enter the healthcare system in multiple ways.  We utilized electronic health records (EHR) to more comprehensively describe point of entry into a large, regional pediatric healthcare network for children with concussion.

Methods: All patients, age 0-17 years, who had at least one clinical encounter with an ICD-9-CM diagnosis of concussion in The Children's Hospital of Philadelphia’s (CHOP) EHR system (7/1/2010−6/30/2014) were selected and their initial concussion-related encounter identified. Initial encounter location was described by relevant variables.

Results: 14,054 patients were included (average age: 12.1 years).  Overall, 45% had their first encounter within primary care, 27%: specialty care, 6%: after-hours triage, and 19%: ED.  For those with a CHOP primary care provider, 72% had their initial encounter within primary care and 11% within the ED.  Healthcare entry varied by age with 0-4 year olds more often entering via the ED (37%) or after hours (26%) versus older children who entered via primary care (5-11: 69%; 12-14: 77%, 15-17: 78%). 

Conclusions: This approach leveraged a unified EHR system across a large care network to describe the point of healthcare entry for children with a concussion across age and healthcare setting. Findings suggest that estimates of concussion incidence based solely on ED records likely underestimate the burden of injury and that point of entry varies by age.