Establishment of a multidisciplinary concussion program: impact of standardization on patient care and resource utilization.
OBJECTIVE
Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center.


METHODS
This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care.


RESULTS
Five hundred eighty-nine patients were identified, including 270 before standardization (2007-2011) and 319 after standardization (2011-2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol.


CONCLUSIONS
A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.
Division of Neurosurgery, Department of Surgery, and.
Sara Anne
SA
Wilkins
Chevis N
CN
Shannon
Steven T
ST
Brown
E Haley
EH
Vance
Drew
D
Ferguson
Kimberly
K
Gran
Marshall
M
Crowther
John C
JC
Wellons
James M
JM
Johnston
D000293:Adolescent; D000407:Alabama; D001265:Athletic Injuries / Q000150:complications / Q000628:therapy; D001924:Brain Concussion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008499:Medical Records; D005791:Patient Care / Q000592:standards; D010348:Patient Care Team / Q000592:standards; D015397:Program Evaluation / Q000592:standards*; D012017:Referral and Consultation; D012189:Retrospective Studies