CHARACTERISTICS AND COSTS OF PEDIATRIC EMERGENCY DEPARTMENT VISITS FOR SPORTS- AND RECREATION-RELATED CONCUSSIONS, 2006-2014

Background: Although concussion-related emergency department (ED) visits increased after the passage of concussion laws, little is known about how the laws may disproportionately impact ED utilization and associated health care costs among children in different demographic groups. Objective: Our aim was to examine the patient and clinical characteristics of pediatric ED visits and associated health care costs for sports-and recreation-related concussions (SRRCs) before and after concussion law enactment. Methods: We retrospectively analyzed ED visits for SRRCs by children ages 5-18 years between 2006 and 2014 in the Pediatric Health Information System database (n = 123,220). ED visits were categorized as "prelaw,'' "immediate post-law,'' and "post-law'' according to the respective state concussion law's effective date. Multinomial logistic regression models were used to assess the impact of the law on ED utilization. Results: The majority of visits were by males (n = 83,208; 67.6%), children aged 10-14 years (n = 49,863; 40.9%), and privately insured patients (n = 62,376; 50.6%). Female sex, older age, and insured by Medicaid/Medicare were characteristics associated with increased ED visits during the immediate post-law and post-law periods compared to their counterparts. A significant decrease in proportion of imaging use was observed from pre-law to post-law (adjusted odds ratio 0.49; 95% confidence interval 0.47-0.50; p < 0.0001). While annual adjusted costs per ED visits decreased, annual total adjusted costs per hospital for SRRCs increased from pre-law to post-law (p < 0.0001). Conclusions: Concussion laws might have impacted pediatric concussion-related ED utilization, with increased annual total adjusted costs. These results may have important implications for policy interventions and their effects on health care systems. (C) 2019 Elsevier Inc. All rights reserved.