title: After-Hours Call Center Triage of Pediatric Head Injury: Outcomes After a Concussion Initiative.
abstract: OBJECTIVE
  The aim of the study was to characterize referral patterns and medical outcomes of children with head injury triaged by an after-hours call center of a large urban pediatric network, both before and after an institutional concussion initiative. The initiative included a revised call center triage algorithm referring patients with a suspected concussion to see a primary care provider (PCP) within 24 hours, concussion-specific continuing education for medical providers, and a new concussion information Web site.
  
  
  METHODS
  Patients aged 5 to 18 years with head injury using the after-hours call center were identified by retrospective review of electronic medical records before (2011) and after (2012) the initiative. A random 50% sample was taken from each year for further analysis.
  
  
  RESULTS
  A total of 127 and 159 eligible patient encounters were randomly selected from 2011 to 2012, respectively. From 2011 to 2012, PCP referrals significantly increased from 7% (95% confidence interval [CI], 4%-13%) to 38% (95% CI, 31%-45%), P < 0.001. Concussion diagnoses also significantly increased from 35% (95% CI, 27%-44%) to 58% (95% CI, 50%-66%), P < 0.001. Emergency department referrals and head computed tomography scans decreased but the differences were not statistically significant. No patients had intracranial injury on computed tomography. Most injuries were not sports related.
  
  
  CONCLUSIONS
  After an institutional concussion initiative including implementation of a revised head trauma telephone triage algorithm, more head injuries were evaluated by PCPs and more concussions were ultimately diagnosed without an increase in emergency department referrals. Clinicians can benefit from continuing education and infrastructure to aid in initial concussion diagnosis and management.
authors.affiliation: From the *Division of Pediatric Emergency Medicine, Johns Hopkins Hospital, Baltimore MD; †After Hours Program and Pediatric Research Consortium, Center for Biomedical Informatics, ‡Sports Medicine and Performance Center, and §Division of Emergency Medicine and Center for Injury Research and Prevention, The Children's Hospital of Philadelphia; ∥Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; and ¶Department of Emergency Medicine and Injury Prevention Center, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Fishe
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Luberti
authors.forename: Christina L
authors.initials: CL
authors.lastname: Master
authors.forename: Roni L
authors.initials: RL
authors.lastname: Robinson
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Grady
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001924:Brain Concussion / Q000175:diagnosis*; D000070456:Call Centers / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014218:Triage / Q000706:statistics & numerical data*