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Primary care is point of entry for many kids with concussions

May 31, 2016

Many children with concussion initially sought care through primary care and not the emergency department, although younger children and those insured by Medicaid were more likely to go to the ED, according to an article published online by JAMA Pediatrics.

Concussion diagnosis is symptom-based and does not require advanced diagnostic tools such as imaging. A better understanding of the points of health care entry for children with concussion is necessary to guide health care networks and clinicians on where training and resources should be directed.

Kristy B. Arbogast, Ph.D., of the Children's Hospital of Philadelphia (CHOP), and coauthors used the electronic health record system at CHOP to describe the health care point of entry for concussion from 2010 to 2014. CHOP's network includes more than 50 locations throughout southeastern Pennsylvania and southern New Jersey, including 31 primary care centers, 14 specialty care centers, an inpatient hospital, two EDs and two urgent care centers that support more than 1 million annual visits.

The study included 8,083 children (17 and younger) who had an initial in-person clinical visit for concussion. The median age of children was 13 and most were non-Hispanic white and had private insurance.

Overall, nearly 82 percent (n=6,624) of children had their first concussion visit at CHOP in primary care, while 11.7 percent had that first visit in an ED, according to the results.

Where children sought initial concussion care varied by age, with 52 percent of children up to age 4 years old going to the ED and more than three-quarters of those children 5 to 17 years old using primary care as their health care entry point. More children covered by Medicaid also used the ED for concussion care, results show.

Study limitations include the use of data from a single health care network.

"Efforts to measure the incidence of concussion cannot solely be based on emergency department visits, and primary care clinicians must be trained in concussion diagnosis and management," the study concludes.
(JAMA Pediatr. Published online May 31, 2016. doi:10.1001/jamapediatrics.2016.0294. Available pre-embargo to the media at

Editor's Note: The study includes funding/support disclosures. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Media Advisory: To contact corresponding author Kristy B. Arbogast, Ph.D., call Camillia Travia at 267-426-6251 or email

To place an electronic embedded link to this study in your story Links will be live at the embargo time:

The JAMA Network Journals

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