Department of Pediatrics, University of Utah (Drs Keenan and Murphy) and Intermountain Healthcare (Mr Staheli and Dr Savitz), Salt Lake City, Utah.
J Head Trauma Rehabil. 2013 Nov-Dec;28(6):426-32. doi: 10.1097/HTR.0b013e31825935b8.
To compare the healthcare use by children with and without a traumatic brain injury (TBI) in the year following injury to understand whether children access primary care.
Children 0 to 15 years with a TBI (N = 545) and (N = 2310) uninjured age and sex-matched comparisons.
A full benefits healthcare plan from 2000 to 2007.
Mean annual healthcare utilization.
Children with TBI had higher mean annual outpatient visits (4.2 vs. 3.5, P = .001), but similar mean annual general pediatric visits (2.7 vs. 2.8, P = .3) than comparison children. More cases than comparisons attended a general pediatric visit (80.0% vs. 73.3%, risk ratio = 1.1, 95% CI: 1.0-1.1). However, approximately 50% of children older than 7 years who had an intracranial injury did not attend a general pediatric visit and those were slightly more likely to receive specialty care (adjusted risk ratio = 1.1, 95% CI: 1.0-1.2). These children did not appear to be substituting specialty for primary care.
Children with a full benefits insurance plan do not access primary care routinely after TBI. These findings present a challenge for designing a system to screen children after TBI.
比较受伤后一年内有创伤性脑损伤（TBI）和无 TBI 的儿童的医疗保健利用情况，以了解儿童是否接受初级保健。
0 至 15 岁的 TBI 儿童（N=545）和未受伤的年龄和性别匹配的对照儿童（N=2310）。
2000 年至 2007 年的全面福利医疗保健计划。
平均年度医疗保健利用情况。
TBI 儿童的年平均门诊就诊次数较高（4.2 次与 3.5 次，P=0.001），但与对照儿童相比，年平均普通儿科就诊次数相似（2.7 次与 2.8 次，P=0.3）。更多的病例比对照儿童接受了普通儿科就诊（80.0%比 73.3%，风险比=1.1，95%可信区间：1.0-1.1）。然而，约有 50%的颅内损伤儿童年龄大于 7 岁未接受普通儿科就诊，他们更有可能接受专科治疗（调整后的风险比=1.1，95%可信区间：1.0-1.2）。这些儿童似乎并没有用专科医疗代替初级医疗保健。
有全面福利保险计划的儿童在 TBI 后并不常规接受初级保健。这些发现对设计 TBI 后儿童筛查系统提出了挑战。
