title: Impact of a state concussion law on pediatric emergency department visits.
abstract: OBJECTIVE
  Many states have passed concussion laws that mandate that players undergo medical clearance before returning to play. Few data have been collected on the impact of such laws on emergency department (ED) visits. This study measures the impact of Rhode Island concussion legislation on sports-related concussion visits to a pediatric ED.
  
  
  METHODS
  International Classification of Diseases, Ninth Revision, Clinical Modification codes with injury mechanism-associated E-codes were extracted from hospital databases from 2004 to 2011 for both sports-related concussions and sports-related ankle ligamentous injuries (comparison group). Visit rates for sports-related concussions were compared before and after the passage of the state concussion law.Secondary outcome measures included rates of head imaging per ED visit for concussion before and after passage of the law. Times series analysis was used to analyze season-to-season count and rate changes.
  
  
  RESULTS
  Overall rate of sports-related concussion visits more than doubled (2.2-fold increase; 95% confidence interval, 1.3-3.6; adjusted P = 0.01) during the fall sports season following the implementation of legislation (2010) relative to the previous year (3.6% vs 1.4%). Rates of sports-related ankle sprain visits tended to increase during the fall sports season but did not achieve statistical significance. Rates of computed tomography scan imaging of the head did not change over time.
  
  
  CONCLUSIONS
  The data from this study revealed an increase in pediatric ED visits for sports-related concussions, without a corresponding increase in head imaging, suggesting that the passage of a state concussion law has led to increased vigilance in evaluation of sports-related concussions, without an increase in diagnostic computed tomography scans.
authors.affiliation: From the Departments of *Emergency Medicine and †Pediatrics, Alpert Medical School of Brown University; ‡Lifespan Information Services; and §Department of Orthopedics and Surgery, ∥Brown University, Providence, RI.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Mackenzie
authors.forename: Patrick
authors.initials: P
authors.lastname: Vivier
authors.forename: Steven
authors.initials: S
authors.lastname: Reinert
authors.forename: Jason
authors.initials: J
authors.lastname: Machan
authors.forename: Caroline
authors.initials: C
authors.lastname: Kelley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000453:epidemiology*; D001265:Athletic Injuries / Q000453:epidemiology*; D001924:Brain Concussion / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D012237:Rhode Island; D013177:Sports / Q000331:legislation & jurisprudence*