Background While our understanding of concussion as an important public health issue among children has grown, broad description of paediatric concussions is limited to high school sports or those treated in an emergency department (ED). Further, non-specialist providers report inadequate training and infrastructure to systematically diagnose and manage these patients. To address these gaps, CHOP and CDC have initiated a novel collaborative effort to examine whether electronic health records (EHRs) can expand traumatic brain injury (TBI) surveillance and research–with a focus on concussion–and to assess whether EHR-based initiatives can improve TBI management.
Methods All patients, age 0–17 years, with at least one clinical encounter with an ICD-9-CM diagnosis of concussion in the CHOP EHR system (7/2010−6/2014) were selected and their initial concussion-related encounter identified.
Results 14,054 patients were included (average age: 12.1 years). Initial analyses indicate that: 50% of patients had their first encounter within primary care and 27% within specialty care; half of all concussions among 5–11 year olds were sports/recreation-related; and introduction of a concussion clinical support tool substantially improved documentation of concussion-specific assessment in the EHR (2% before vs. 70% after implementation in July 2012).
Conclusions This collaborative program leverages the strength of a linked EHR system throughout a large healthcare network (>1 million annual visits) to provide a comprehensive system-wide assessment of paediatric concussion across the developmental age spectrum beyond the ED setting. This is the first such US assessment that included a diverse demographic and socioeconomic sample. This work highlights the potential of EHRs to guide clinical management and facilitate research that can lead to improved concussion prevention and diagnosis.
- electronic health records
- traumatic brain injury