title: Trends in Ambulatory Care for Children with Concussion and Minor Head Injury from Eastern Massachusetts between 2007 and 2013.
abstract: OBJECTIVE
  To characterize trends in health care utilization and costs for children diagnosed with concussion or minor head injury within a large pediatric primary-care association.
  
  
  METHODS
  We conducted a retrospective cohort analysis from 2007 through 2013 examining all outpatient medical claims related to concussion and minor head injury from 4 commercial insurance companies for children 6-21 years of age who were patients within a large pediatric independent practice association located throughout eastern Massachusetts.
  
  
  RESULTS
  Health care visits for concussion and minor head injury increased more than 4-fold during the study period, with primary-care and specialty clinics experiencing the greatest increases in the rate of visits while emergency department visits increased comparatively less. These increases were accounted for by both the proportion of children diagnosed with concussion or minor head injury (1.3% of all children in 2007 vs 3.3% in 2013) and the number of encounters per diagnosed patient (1.0 encounters per patient in 2007 vs 1.7 in 2013). Although the overall population costs devoted to care for concussion or minor head injury increased 34%, the cost per individual diagnosed child decreased 31%.
  
  
  CONCLUSIONS
  Over the past 7 years, health care encounters for children diagnosed with concussion or minor head injury increased substantially in eastern Massachusetts. Care for these injuries increasingly shifted from the emergency department to primary-care and specialty providers.
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Boston Children's Hospital, Boston, MA. Electronic address: alex.taylor@childrens.harvard.edu.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Taylor
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.affiliation: Pediatric Physicians' Organization at Children's, Boston, MA.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Saillant
authors.affiliation: Pediatric Physicians' Organization at Children's, Boston, MA.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Trudell
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Boston, MA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Proctor
authors.affiliation: Pediatric Physicians' Organization at Children's, Boston, MA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Modest
authors.affiliation: Pediatric Physicians' Organization at Children's, Boston, MA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
authors.forename: Louis
authors.initials: L
authors.lastname: Vernacchio
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data* / Q000639:trends*; D001924:Brain Concussion / Q000191:economics / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000191:economics / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D055815:Young Adult