Purpose Healthcare utilisation for sports-related concussions increased significantly following the enactment of concussion laws in all 50 states. This study examined the patient and visit characteristics of paediatric Emergency Department (ED) visits and associated healthcare costs for sports-related concussions before and after the concussion law enactment.

Method We retrospectively analysed ED visits by children ages 5–18 between 2006 and 2015 in the Paediatric Health Information System database. ED visits corresponding state law effective date were coded as ‘0’, with one unit of subtraction for each additional year before, and one unit of addition for each additional year after. Multinomial logistic regression models were used to assess the impact of the law on ED utilisation and associated healthcare costs.

Results Of the 123,220 ED visits due to sport-related concussions identified, majority were males (n=83,208; 67.6%), children ages 10 to 14 years (n=49,863; 40.9%), and privately insured (n=62,376; 50.6%). Females, older age, and patients with Medicaid/Medicare each had significantly increased odds of ED visits in both the immediate post-law and post-law periods as compared to their counterparts. A significantly decreased proportion of imaging use was also observed post-law compared to pre-law (AOR: 0.49, 95% CI: 0.47, 0.50, p<0.0001). Total adjusted costs per hospital for sports-related concussions were increased from pre-law to post-law (p<0.0001), although imaging use and adjusted costs per ED visits decreased.

Conclusion Concussion laws impacted paediatric concussion-related ED utilisation by patient and visit characteristics, with increased total adjusted costs. These results have important implications for policy interventions and their effects on healthcare systems.

Contribution to Injury Prevention This study offers empirical data on the impact of state concussion laws on ED utilisation for paediatric sports-related concussions. Future policy interventions should target preventing concussion before it occurs to reduce healthcare burden.