Healthcare utilization in the first year after pediatric traumatic brain injury in an insured population.
OBJECTIVE
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.


METHODS
Children 0 to 15 years with a TBI (N = 545) and (N = 2310) uninjured age and sex-matched comparisons.


METHODS
A full benefits healthcare plan from 2000 to 2007.


METHODS
Mean annual healthcare utilization.


RESULTS
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.


CONCLUSIONS
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.
Department of Pediatrics, University of Utah (Drs Keenan and Murphy) and Intermountain Healthcare (Mr Staheli and Dr Savitz), Salt Lake City, Utah.
Heather T
HT
Keenan
Nancy A
NA
Murphy
Russ
R
Staheli
Lucy A
LA
Savitz
D001930:Brain Injuries / Q000191:economics / Q000534:rehabilitation*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health; D008297:Male; D020380:Needs Assessment; D011320:Primary Health Care / Q000706:statistics & numerical data*