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Children's Concussion Rates May Be Wildly Underestimated in U.S.

A vast majority of children with concussions go to primary care doctors rather than the emergency department, according to a study published online last month in JAMA Pediatrics, which may lead to youth-concussion rates being drastically underestimated.

The study authors examined data from just over 8,000 children ages 17 or younger who went to the Children's Hospital of Philadelphia (CHOP) network from July 1, 2010, through June 30, 2014, for a concussion. They discovered that nearly 82 percent of patients had their first concussion visit with a primary care physician, while less than 12 percent went to the emergency department. Thus, relying solely on data for children who are admitted to the emergency department—which a number of studies have done with regard to youth-concussion rates—could wildly undersell the frequency of concussions among youths.

Age played a large part in where patients sought their first visit for a concussion. More than half of children between the ages of 0 and 4 went straight to the emergency department (191 of the 368 included in the study), whereas the percentage significantly decreased for children as they grew older. Only 371 of the 2,492 children between the ages of 5 and 11 immediately went to the emergency department (14.9 percent), while 222 of 2,820 of children between the ages of 12 and 14 did so (7.9 percent) and 163 of 2,403 (6.8 percent) of those aged 15-17 followed suit. More than three-quarters of the children between the ages of 5 and 17 had their initial visit for a concussion with a primary care physician.

Discounting visits to primary care physicians isn't the only way previous studies may have undercounted youth-concussion rates. A number of those studies rely largely upon data from high school athletes, but 2,860 of the 8,083 children seen at the CHOP network for a concussion over this four-year span were under the age of 12.

"We need surveillance that better captures concussions that occur in children and adolescents," said Dr. Debra Houry, director of the Centers of Disease Control and Prevention's National Center for Injury Prevention and Control, in a statement. "Better estimates of the number, causes, and outcomes of concussion will allow us to more effectively prevent and treat them, which is a priority area for CDC's Injury Center."

Since a grand majority of patients are visiting primary care physicians on initial consult rather than going straight to the emergency department, the study authors believe those doctors must be trained specifically in concussion diagnosis and management.

"This study provides direction for healthcare networks and clinicians about the critical importance of providing targeted training and resources in primary care settings," said Dr. Christina Master, a study co-author and pediatric sports medicine specialist at CHOP, in a statement. "With targeted training and support, pediatric primary care providers are well-positioned to diagnose and treat the vast majority of concussions."

In the meantime, studies that rely solely on emergency department data for youth-concussion rates must be taken with a hefty grain of salt.


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