Concussion coming soon to a clinic near you

Abstract

Over the last decade, there has been a sharp increase in the diagnosis of concussion, owing to broader definitions and increased public and physician awareness of brain injury. A growing body of research, published in The Journal and elsewhere, has highlighted suboptimal clinical awareness, diagnosis, and management, with the investigators often hailing from emergency departments throughout North America. Is concussion a diagnosis handled mostly in the emergency department? In this issue, Taylor et al characterize trends in health care utilization and costs for children diagnosed with concussion or minor head injury within a large regional pediatric network from 2007 to 2013. During that time period, the rate of concussion more than doubled. The proportion of head injuries diagnosed as concussion rose from 42% to 72%. In 2007, more than one-half of new concussion diagnoses were seen in emergency departments; by 2013 less than 30% were evaluated in emergency departments and just over one-half of new diagnoses were seen by a primary care provider. Meanwhile, the mean overall cost per unique patient diagnosed with concussion declined from 2007 to 2013. Wherever you practice, concussion will be coming soon to a clinic near you. Given the observed lower cost per patient in this study, we can speculate that milder cases of concussion are increasingly being diagnosed. There is growing vigilance about concussion. All these trends merit close attention now and in the future. With an explosion of new pediatric sports medicine facilities and concussion clinics staffed by pediatricians, neurosurgeons, neurologists, orthopedists, emergency medicine and sports medicine physicians, and others, we will need to strike a balance between under- and over-diagnosis of concussion. We will need to be mindful of economic forces driving the creation of concussion centers and insure that we serve patients with concussions, without debilitating well children or children minimally affected by any head contact. Article page 738▶ Trends in Ambulatory Care for Children with Concussion and Minor Head Injury from Eastern Massachusetts between 2007 and 2013The Journal of PediatricsVol. 167Issue 3PreviewTo characterize trends in health care utilization and costs for children diagnosed with concussion or minor head injury within a large pediatric primary-care association. Full-Text PDF