Diagnosis and acute management of patients with concussion at children's hospitals

Objectives: To describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients. Design: Cross-sectional study. Setting: Children's hospitals participating in the Pediatric Health Information System in the USA during a 10-year period. Patients: All emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion. Main outcome measures: The proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion. Results: The number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US$695, IQR US$472-$1009, vs US$191, IQR US$114-$287). An ED visit with CT, however, cost less than a hospitalisation without CT (US$1907, IQR US$1292-$3770). Conclusions: Although the number of ED patients diagnosed with concussion has increased, the number admitted has remained stable. Concussion patients at paediatric hospitals in the USA commonly undergo CT imaging and receive medication.