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. 2018 Mar;29(2):269-279.
doi: 10.1097/EDE.0000000000000791.

The Epidemiology of Pediatric Head Injury Treated Outside of Hospital Emergency Departments

Cheryl K Zogg, R Sterling Haring, Likang Xu, Joseph K Canner, Hatim A AlSulaim, Zain G Hashmi, Ali Salim, Lilly D Engineer, Adil H Haider, Jeneita M Bell, Eric B Schneider

The Epidemiology of Pediatric Head Injury Treated Outside of Hospital Emergency Departments

Cheryl K Zogg et al. Epidemiology. 2018 Mar.

Abstract

Background: Although head trauma-related deaths, hospitalizations, and emergency department visits are well characterized, few studies describe pediatric patients presenting outside of emergency departments. We compared the epidemiology and extent of healthcare-seeking pediatric (0-17 years) patients presenting in outpatient settings with those of patients seeking nonhospitalized emergency department care.

Methods: We used MarketScan Medicaid and commercial claims, 2004-2013, to identify patients managed in two outpatient settings (physician's offices/clinics, urgent care) and the emergency department. We then examined differences in demographic and injury-specific factors, Centers for Disease Control and Prevention-defined head trauma diagnoses, the extent of and reasons for post-index visit ambulatory care use within 30/90/180 days, and annual and monthly variations in head trauma trends. Outpatient incidence rates in 2013 provided estimates of the nationwide US outpatient burden.

Results: A total of 1,683,097 index visits were included, representing a nationwide burden in 2013 of 844,660 outpatient cases, a number that encompassed 51% of healthcare-seeking head trauma that year and that substantially increased in magnitude from 2004 to 2013. Two-thirds (68%) were managed in outpatient settings. While demographic distributions varied with index-visit location, injury-specific factors were comparable. Seasonal spikes appeared to coincide with school sports.

Conclusions: There is an urgent need to better understand the natural history of head trauma in the >800,000 pediatric patients presenting each year for outpatient care. These outpatient injuries, which are more than double the number of head trauma cases recorded in the hospital-affiliated settings, illustrate the potential importance of expanding inclusion criteria in surveillance and prevention efforts designed to address this critical issue.

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Conflict of interest statement

Conflict of interest: Two of the study's co-authors, Likang Xu, MD, MS, and Jeneita M. Bell, MD, MPH, are employees of the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Figures

Figure 1
Figure 1
Head trauma (traumatic brain injury) pyramid as first conceptualized by the CDC in 2004. Values represent the national burden of deaths, hospitalizations, and emergency department visits among pediatric patients aged 0-17y estimated by the CDC in 2013. Reported deaths represent Record-Axis Condition codes collected by the CDC's National Center for Injury Prevention and Control, non-fatal inpatient hospitalizations were taken from the Agency for Healthcare Research and Quality's (AHRQ's) Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, and non-hospitalized emergency department vistis were taken from the AHRQ's HCUP Nationwide emergency department Sample—consistent with methods currently employed by the CDC.
Figure 2
Figure 2
(a) Average (mean) number of subsequent ambulatory visits within 30, 90, and 180 days per index ambulatory pediatric head trauma presentation from 2010-2013. (b) Extrapolated 2013 national burden of pediatric index and subsequent ambulatory care visits (routine and injury-related) within 30, 90, and 180 days. Estimates are inclusive of uninsured patients.
Figure 2
Figure 2
(a) Average (mean) number of subsequent ambulatory visits within 30, 90, and 180 days per index ambulatory pediatric head trauma presentation from 2010-2013. (b) Extrapolated 2013 national burden of pediatric index and subsequent ambulatory care visits (routine and injury-related) within 30, 90, and 180 days. Estimates are inclusive of uninsured patients.
Figure 3
Figure 3
Annual rates of healthcare-seeking head trauma presentation per 100,000 pediatric enrollees from 2004-2013 and joinpoint-regression results (overall and stratified by index-visit location) among (a) privately insured and (b) Medicaid patients. Percentages represent the average annual percent change. (c) Seasonal variation in outpatient presentation. Results represent monthly rates of healthcare-seeking head trauma visits per 100,000 pediatric enrollees from January 2010-December 2013.
Figure 3
Figure 3
Annual rates of healthcare-seeking head trauma presentation per 100,000 pediatric enrollees from 2004-2013 and joinpoint-regression results (overall and stratified by index-visit location) among (a) privately insured and (b) Medicaid patients. Percentages represent the average annual percent change. (c) Seasonal variation in outpatient presentation. Results represent monthly rates of healthcare-seeking head trauma visits per 100,000 pediatric enrollees from January 2010-December 2013.
Figure 3
Figure 3
Annual rates of healthcare-seeking head trauma presentation per 100,000 pediatric enrollees from 2004-2013 and joinpoint-regression results (overall and stratified by index-visit location) among (a) privately insured and (b) Medicaid patients. Percentages represent the average annual percent change. (c) Seasonal variation in outpatient presentation. Results represent monthly rates of healthcare-seeking head trauma visits per 100,000 pediatric enrollees from January 2010-December 2013.
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