School of Public Policy, University of Calgary, Calgary, AB, Canada.
Alberta Health Services, Calgary, AB, Canada.
Pediatr Res. 2023 May;93(6):1752-1764. doi: 10.1038/s41390-022-02214-5. Epub 2022 Sep 9.
We described longitudinal trends in the incidence of episodes of care (EOC) and follow-up care for pediatric concussion in relation to age, sex, rurality of patient residence, point of care, and area-based socioeconomic status (SES) in Alberta, Canada.
A retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients <18 years of age who received a diagnosis of concussion, other specified injuries of head, unspecified injury of head, or post-concussion syndrome between April 1, 2004 and March 31, 2018. Data were geospatially mapped.
Concussion EOCs increased 2.2-fold over the study period, follow-up visits 5.1-fold. Care was increasingly received in physician office (PO) settings. Concussion diagnoses in rural and remote areas occurred in emergency department (ED) settings more often than in metro centres or urban areas (76%/75% vs. 52%/60%). Proportion of concussion diagnoses was positively related to SES and age. Diagnosis and point of care varied geographically.
The shift in care to PO settings, increased incidence of all diagnoses, and the higher use of the ED by some segments of the population all have important implications for appropriate clinical management and the efficient provision of health care for pediatric concussion.
This is the first study to use EOC to describe longitudinal trends in incidence and follow-up care for pediatric concussion in relation to age, sex, rurality, point of care, and area-based SES. We report increased incidence of concussion in both emergency and outpatient settings and the proportion of diagnoses was positively related to SES and age. Patients increasingly received care for concussion in PO over time. Geospatial mapping indicated that the incidence of concussion and unspecified injury of head varied geographically and temporally. Results have important implications for appropriate clinical management and efficient provision of health care following pediatric concussion.
我们描述了加拿大艾伯塔省与年龄、性别、患者居住地的农村/城市程度、护理地点以及基于区域的社会经济地位（SES）相关的儿科脑震荡患者护理发作（EOC）和随访护理的纵向趋势。
这是一项回顾性基于人群的队列研究，使用链接的全省行政健康数据，对所有 2004 年 4 月 1 日至 2018 年 3 月 31 日期间接受脑震荡、头部其他特指损伤、头部未特指损伤或脑震荡后综合征诊断的<18 岁患者进行研究。数据进行了地理空间映射。
研究期间，脑震荡 EOC 增加了 2.2 倍，随访就诊增加了 5.1 倍。护理越来越多地在医生办公室（PO）进行。农村和偏远地区的脑震荡诊断比大都市中心或城市地区更常发生在急诊室（ED）（76%/75%比 52%/60%）。脑震荡诊断的比例与 SES 和年龄呈正相关。诊断和护理地点在地理上存在差异。
护理向 PO 环境转移、所有诊断的发生率增加，以及某些人群更多地使用 ED，这些都对儿科脑震荡的适当临床管理和高效提供医疗保健具有重要意义。
这是第一项使用 EOC 描述与年龄、性别、农村/城市程度、护理地点和基于区域的 SES 相关的儿科脑震荡发生率和随访护理纵向趋势的研究。我们报告称，急诊和门诊环境中脑震荡的发生率均有所增加，且诊断比例与 SES 和年龄呈正相关。患者随时间推移越来越多地在 PO 接受脑震荡护理。地理空间映射表明，脑震荡和头部未特指损伤的发生率在地理和时间上存在差异。结果对儿科脑震荡后适当的临床管理和高效的医疗保健提供具有重要意义。
