Characterizing Hospitalizations for Pediatric Concussion and Trends in Care

Background: Children hospitalized for concussion may be at a higher risk for persistent symptoms, but little is known about this subset of children.

Objective: Delineate a cohort of children admitted for concussion, describe care practices received, examine factors associated with prolonged length of stay (LOS) or emergency department (ED) readmission, and investigate changes in care over time.

Design, setting: Retrospective analysis of data submitted by 40 pediatric hospitals to the Pediatric Health Information System.

Patients: Children 0 to 17 years old admitted with a primary diagnosis of concussion from 2007 to 2014.

Measurements: Descriptive statistics characterized this cohort and care practices delivered, logistic regression identified factors associated with a LOS of =2 days and ED readmission, and trend analyses assessed changes in care over time.

Results: Of the 10,729 children admitted for concussion, 68.7% received intravenous pain or antiemetic medications. Female sex, adolescent age, and having government insurance were all associated (P = .02) with increased odds of LOS = 2 days and ED revisit. Proportions of children receiving intravenous ondansetron (slope = 1.56, P = .001) and ketorolac (slope = 0.61, P < .001) increased over time, and use of neuroimaging (slope = -1.75, P < .001) decreased.

Conclusions: Although concussions are usually selflimited, hospitalized children often receive intravenous therapies despite an unclear benefit. Factors associated with prolonged LOS and ED revisit were similar to predictors of postconcussive syndrome. Since there has been an increased use of specific therapeutics, prospective evaluation of their relationship with concussion recovery could lay the groundwork for evidenced-based admission criteria and optimize recovery.