From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Surgery, St. John's Episcopal Hospital, Far Rockaway, NY.
Pediatr Emerg Care. 2022 Feb 1;38(2):e683-e689. doi: 10.1097/PEC.0000000000002368.
To describe demographic, injury, and clinical characteristics of pediatric patients treated in the ED for mild traumatic brain injury (mTBI), and to evaluate characteristics associated with mTBI-related return emergency department (ED) visit within 1 month of initial presentation.
Retrospective cohort study from April 1, 2012, to September 30, 2017, of children 19 years or younger presenting to any Maryland ED for mTBI identified in the Maryland Health Services Cost Review Commission database using ICD-9/10 codes. Demographic, injury, and clinical characteristics of individuals were collected. The primary outcome was mTBI-related return ED visit within 4 weeks. Multiple logistic regression tested the associated of individual demographic, injury, and clinical characteristics with mTBI-related return ED visit.
There were 25,582 individuals who had an ED visit for mTBI, of which 717 (2.8%) returned to the ED within 4 weeks and 468 (1.8%) within 1 week with a mTBI-related diagnosis. In multivariable logistic regression analyses, public insurance (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.21-1.72) and female sex (aOR, 1.34; 95% CI, 1.15-1.56) were associated with increased odds of return to the ED within 4 weeks. Age younger than 2 years (aOR, 0.39; 95% CI, 0.21-0.72) was associated with decreased odds of return visit. There was a trend toward decreased odds of return patients receiving computed tomography head imaging (aOR, 0.86; 95% CI, 0.74-1.01).
Although return to the ED for mTBI-related complaints is uncommon, girls, older children, and publicly insured individuals may be at increased risk. Future targeted study may identify areas to improve access to appropriate longitudinal care and justify ED programs to better coordinate follow-up for mTBI.
描述在急诊部接受轻度创伤性脑损伤（mTBI）治疗的儿科患者的人口统计学、损伤和临床特征，并评估与初始就诊后 1 个月内 mTBI 相关的急诊部（ED）就诊相关的特征。
这是一项回顾性队列研究，研究对象为 2012 年 4 月 1 日至 2017 年 9 月 30 日期间在马里兰州卫生服务成本审查委员会数据库中使用 ICD-9/10 代码识别的在马里兰州任何 ED 因 mTBI 就诊的 19 岁或以下的儿童。收集了个人的人口统计学、损伤和临床特征。主要结局是 4 周内 mTBI 相关的 ED 就诊。多变量逻辑回归测试了个体人口统计学、损伤和临床特征与 mTBI 相关的 ED 就诊的相关性。
有 25582 人因 mTBI 就诊，其中 717 人（2.8%）在 4 周内、468 人（1.8%）在 1 周内因 mTBI 相关诊断返回 ED。在多变量逻辑回归分析中，公共保险（调整后的优势比[aOR]，1.44；95%置信区间[CI]，1.21-1.72）和女性（aOR，1.34；95% CI，1.15-1.56）与 4 周内返回 ED 的几率增加相关。年龄小于 2 岁（aOR，0.39；95% CI，0.21-0.72）与就诊减少的几率相关。接受头部计算机断层扫描成像的患者返回的几率呈下降趋势（aOR，0.86；95% CI，0.74-1.01）。
尽管因 mTBI 相关投诉返回 ED 的情况并不常见，但女孩、年龄较大的儿童和有公共保险的人可能面临更高的风险。未来的针对性研究可能会确定改善获得适当纵向护理的途径，并证明 ED 计划可以更好地协调 mTBI 的随访。
