Clinical presentation patterns and settings for pediatric traumatic brain injury at one, large midwest children's hospital

Background: Although many traumatic brain injuries (TBIs) present to emergency departments (EDs), data limited to EDs severely underestimate the incidence of TBI. The objectives were to 1) report the incidence of TBIs across multiple clinical settings in one large, pediatric hospital and 2) investigate potential differences in the diagnosis and management of TBIs by demographic characteristics and clinical setting. Methods: All TBIs sustained by children ≤20 years of age treated at one large Midwest Children's Hospital from August 1, 2010 through July 31, 2011 were identified using ICD-9 codes 310.2, 800-801.9, 803-804.9, 850-854.16, and 959.01. Results: 3,971 individuals ≤20 years of age were seen during 5,429 TBI-related visits. The majority of TBI-related visits were for unspecified head injuries (47.4%) or concussions (40.6%); and 92.0% were classified as mild TBI-related. Although the most common treatment site/setting was ED, it represented only 32.7% of all visits. Clinic outpatient (31.4%) and urgent care (27.6%) were other common settings. A higher proportion of white patients was diagnosed with concussion, had commercial insurance, and had two or more related visits compared to Black/African American patients. Conclusions: This study, the first to describe pediatric TBIs across all clinical settings at one large pediatric hospital, found only one third of pediatric TBI visits were in the ED and 92% of TBIs could be classified as mild. Investigating TBIs across the full spectrum of clinical care is needed to provide both clinicians and policy makers with a better understanding of the true incidence of pediatric TBI.