Sports related concussions by patient age

The ED visits for sports related concussion are highly concentrated in school age children. Figure 1 shows the age distribution of sports related and non-sports related concussions in 2008. Of all ED visits for sports related concussion, more than half (57.9 percent) were for high school age children (14–18 years of age). Another 16.8 percent were for middle school age children (11–13 years of age). Less than one-tenth of ED patients diagnosed with sports related concussion were 24 and older. In contrast, the majority of non-sports related concussion ED visits (58.4 percent) occurred in patients 24 and older.

Figure 1

Age distribution for sports related compared to non-sports related concussions, 2008. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2008

Patient discharge status for sports related concussions

Figure 2 shows that the vast majority (95.4 percent) of ED visits in patients with a sports related concussion were discharged home. Only 3.7 percent of patients were admitted to the same hospital or transferred to another hospital for further treatment. For ED visits following non-sports related concussions, 17.3 percent were admitted or transferred to another hospital.

Figure 2

Discharge status of ED visits for sports related compared to non-sports related concussions, 2008. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2008

Level of consciousness by patient discharge status for sports related concussion

A higher proportion of patients who were hospitalized after an ED visit for sports related concussion experienced loss of consciousness than those who were discharged home (figure 3). Thirty-six percent of hospitalized patients experienced brief loss of consciousness, compared to 20.7 percent of those sent home. The proportion of hospitalized patients who had suffered moderate or prolonged loss of consciousness (25.2 percent) was more than double that of patients routinely discharged (11.1 percent).

Figure 3

Level of loss of consciousness by patient discharge status for sports related concussions, 2008. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2008

Top conditions associated with sports related concussion

Table 2 provides the top 10 conditions associated with concussion. For ED visits with concussion listed as the principal diagnosis, the associated conditions were less serious than when concussion was listed as a secondary diagnosis. For sports related concussion cases, open wounds of head, neck and trunk, skull and face fractures, and fracture of upper limb were all more frequent when concussion was listed as a secondary condition. Less serious conditions such as a superficial injury or contusion, sprains and strains, and headache were associated with sport related concussion listed as a principal diagnosis.

Table 2

Conditions associated with sports related concussions, 2008.

Diagnoses, ICD-9-CM, and Clinical Classifications Software (CCS)

The principal diagnosis is that condition established after study to be chiefly responsible for the patient’s admission to the hospital. Secondary diagnoses are concomitant conditions that coexist at the time of admission or that develop during the stay. All-listed diagnoses include the principal diagnosis plus these additional secondary conditions.

ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are about 13,600 ICD-9-CM diagnosis codes.

CCS categorizes ICD-9-CM diagnoses into a manageable number of clinically meaningful categories.⁴ This “clinical grouper” makes it easier to quickly understand patterns of diagnoses and procedures.

Case definition

The ICD-9-CM codes defining concussion include diagnosis codes with ‘850’ in the first three digits. Sports related concussion is defined as concussion that has E code ‘E9170’ or ‘E9175’, or ‘E886’.

Types of hospitals included in HCUP

HCUP is based on data from community hospitals, defined as short-term, non-Federal, general and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. Excluded are long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals. Please note, a discharge of this nature will be included in the NIS if it occurred in a community hospital.

Unit of analysis

The unit of analysis is the ED visit or hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the ED or hospital multiple times in one year will be counted each time as a separate “visit” or “discharge” from the hospital.

Region

Region is one of the four regions defined by the U.S. Census Bureau:

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Northeast: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania

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Midwest: Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas

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South: Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas

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West: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Alaska, and Hawaii

Discharge status

Discharge status indicates the disposition of the patient at discharge from the hospital, and includes the following six categories: routine (to home), transfer to another short-term hospital, other transfers (including skilled nursing facility, intermediate care, and another type of facility such as a nursing home), home health care, against medical advice (AMA), or died in the hospital.