Examining Clinic-Based Health Care Use Patterns in a Specialty Concussion Care Setting.

Abstract

To examine clinic-based health care use (HU) patterns (prolonged use, accessibility continuity, comprehensiveness, and intensity) in children with acute and subacute concussion. This retrospective cohort study included patients aged 5-17 years receiving specialty care at an interdisciplinary sports concussion clinic. Patients were dichotomized on the basis of index visit chronicity: acute (≤3 days) and subacute (>3 days) postinjury. Prolonged HU, the primary outcome, was defined as having any follow-up visit >28 days from the index visit. Other measures of HU (accessibility [distance from clinic, insurance status], continuity [visit pacing], comprehensiveness [number and type of referrals], and intensity [number of follow-up visits]) as well as recovery and treatment time were obtained. Multivariable regressions were completed using confounders based upon established literature. Of 622 patients, 362 (58.2%) presented acutely and 260 (41.8%) subacutely. The acute group was more likely to have a history of motion sickness (P = .02), a sport-related mechanism of injury (P = .006), and migrainous presentation (P = .0005), whereas the subacute group was slightly older (P = .002). Despite differences in presentation timing, no significant differences were observed in prolonged HU (P = .17), distance from clinic (P = .41), or insurance status (P = .36). However, patients in the acute group had significantly lower pacing of visits (ie, continuity; P < .001) with greater number of follow-ups (ie, intensity; P < .001) but were less likely to receive interdisciplinary referrals (P < .001). After adjusting for confounding clinical variables, no significant differences in treatment duration were observed between the two groups (P = .90). Initiation of concussion care within 1 week of injury demonstrates comparable effectiveness regardless of exact timing, although early presentation favors single-provider management whereas later presentation requires enhanced interdisciplinary coordination.