Cheryl K Zogg1,2,3, R Sterling Haring2,3,4, Likang Xu5, Joseph K Canner3, Taylor D Ottesen1, Ali Salim2,6, Adil H Haider2,6, Eric B Schneider2,3,7,8. 1. From the Yale School of Medicine, New Haven, CT. 2. Center for Surgery and Public Health: Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham & Women's Hospital, Boston, MA. 3. Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD. 4. Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 5. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. 6. Division of Trauma, Burn, and Surgical Critical Care, Brigham & Women's Hospital, Boston, MA. 7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 8. Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA.
Abstract
BACKGROUND: While deaths, hospitalizations, and emergency department visits for head trauma are well understood, little is known about presentations in outpatient settings. Our objective was to examine the epidemiology and extent of healthcare-seeking adult (18-64 years) head trauma patients presenting in outpatient settings compared with patients receiving nonhospitalized emergency department care. METHODS: We used 2004-2013 MarketScan Medicaid/commercial claims to identify head trauma patients managed in outpatient settings (primary care provider, urgent care) and the emergency department. We examined differences in demographic and injury-specific factors, Centers for Disease Control and Prevention-defined head trauma diagnoses, and extent of and reasons for postindex visit ambulatory care use within 30/90/180 days by index visit location, as well as annual and monthly variations in head trauma trends. We used outpatient incidence rates to estimate the US nationwide outpatient burden. RESULTS: A total of 1.19 million index outpatient visits were included (emergency department: 348,659). Nationwide, they represented a weighted annual burden of 1.16 million index outpatient cases. These encompassed 46% of all known healthcare-seeking head trauma in 2013 (outpatient/emergency department/inpatient/fatalities) and increased in magnitude (+31%) from 2004 to 2013. One fourth (27%) of office/clinic visits led to diagnosis with concussion on index presentation (urgent care: 32%). Distributions of demographic factors varied with index visit location while injury-specific factors were largely comparable. Subsequent visits reflected high demand for follow-up treatment, increased concussive diagnoses, and sequelae-associated care. CONCLUSIONS: Adult outpatient presentations of head trauma remain poorly understood. The results of this study demonstrate the extensive magnitude of their occurrence and close association with need for follow-up care.
BACKGROUND: While deaths, hospitalizations, and emergency department visits for head trauma are well understood, little is known about presentations in outpatient settings. Our objective was to examine the epidemiology and extent of healthcare-seeking adult (18-64 years) head traumapatients presenting in outpatient settings compared with patients receiving nonhospitalized emergency department care. METHODS: We used 2004-2013 MarketScan Medicaid/commercial claims to identify head traumapatients managed in outpatient settings (primary care provider, urgent care) and the emergency department. We examined differences in demographic and injury-specific factors, Centers for Disease Control and Prevention-defined head trauma diagnoses, and extent of and reasons for postindex visit ambulatory care use within 30/90/180 days by index visit location, as well as annual and monthly variations in head trauma trends. We used outpatient incidence rates to estimate the US nationwide outpatient burden. RESULTS: A total of 1.19 million index outpatient visits were included (emergency department: 348,659). Nationwide, they represented a weighted annual burden of 1.16 million index outpatient cases. These encompassed 46% of all known healthcare-seeking head trauma in 2013 (outpatient/emergency department/inpatient/fatalities) and increased in magnitude (+31%) from 2004 to 2013. One fourth (27%) of office/clinic visits led to diagnosis with concussion on index presentation (urgent care: 32%). Distributions of demographic factors varied with index visit location while injury-specific factors were largely comparable. Subsequent visits reflected high demand for follow-up treatment, increased concussive diagnoses, and sequelae-associated care. CONCLUSIONS: Adult outpatient presentations of head trauma remain poorly understood. The results of this study demonstrate the extensive magnitude of their occurrence and close association with need for follow-up care.
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