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Trends in Pediatric Emergency Department Utilization for Mild Traumatic Brain Injury Before and After Legislation

Singichetti, Bhavna, MPH; Leonard, Julie C., MD, MPH; Janezic, Alyssa R., MPH; Li, Hongmei, PhD; Yi, Honggang, PhD; Yang, Jingzhen, PhD, MPH

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p E30–E37
doi: 10.1097/HTR.0000000000000397
Focus on Clinical Research and Practice

Objective: To examine the effect of state youth traumatic brain injury (TBI) legislation on pediatric emergency department (ED) utilization for sports and recreation-related mild TBIs (mTBIs).

Participants: ED visits by children ages 5 to 18 years between 2006 and 2014 in the Pediatric Health Information System database (N = 452 900).

Design: Retrospective analysis.

Main Measures: Rates of ED visits, and injury comparison groups (mTBI, moderate to severe TBI, minor head injury, and long bone fracture).

Results: Of the 452 900 ED visits, 123 192 (27.2%) were for mTBI, along with visits for moderate to severe TBIs (n = 5190), minor head injuries (n = 54 566), and long bone fractures (n = 269 952). ED visits for mTBIs were more common among males (67.5%), children ages 10-14 years (42.1%), and the privately insured (50.6%). The proportion of mTBI ED visits increased significantly, particularly from 5 years prelegislation to immediately postlegislation (57.8 to 94.8 mTBI visits per 10 000 ED visits). A similar trend was observed for minor head injuries; however, no significant changes were observed for moderate to severe TBIs and long bone fractures.

Conclusion: Pediatric ED utilization trends for the injury comparison groups differed from each other, and from pre- and post-TBI legislation. Further research assessing effects of TBI legislation on healthcare utilization is warranted.

Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, Ohio (Mss Singichetti and Janezic and Drs Leonard, Li, Yi, and Yang); The Ohio State University College of Medicine, Columbus (Drs Leonard and Yang); Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China (Dr Li); and Department of Biostatistics, School of Public Health, Nanjing Medical University, China (Dr Yi).

Corresponding Author: Jingzhen Yang, PhD, MPH, Center for Injury Research and Policy at Nationwide Children's Hospital, 700 Children's Dr, RBIII, Columbus, OH 43205 (

The results of this study were presented at the 2016 Pediatric Academic Societies Annual Meeting, in Baltimore, Maryland (April 30 to May 3, 2016).

The authors declare no conflicts of interest.

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