ED Utilization Trends in Sports-Related Traumatic
WHAT’S KNOWN ON THIS SUBJECT: Traumatic brain injury (TBI) in
children causes significant morbidity and mortality. Parental and
coach awareness about brain injury due to sports has recently
increased. Since 2001, pediatric emergency departments have
seen a significant increase in sports-related TBI.
WHAT THIS STUDY ADDS: Pediatric, sports-related TBIs cared for
in the emergency department and admitted to the hospital have
both increased, resulting in no change in the percentage being
admitted. However, patients admitted have had a significant
reduction in injury severity.
BACKGROUND: Emergency department (ED) visits for sports-related
traumatic brain injuries (TBIs) have risen. This study evaluated how
the number and severity of admissions have changed as ED visits for
sports-related TBIs have increased.
1 trauma center was performed. Patients from 2002 to 2011 with a pri-
mary or secondary diagnosis of TBI were identified from the hospital’s
inpatient and outpatient trauma registries. Frequencies were used to
characterize the population, x2analysis was performed to determine
differences between groups, and regression analysis looked at re-
lationship between year and injury severity score or length of stay.
RESULTS: Sport was responsible for injury in 3878 (15.4%) cases dur-
ing the study period; 3506 (90.4%) were discharged from the hospital,
and 372 (9.6%) were admitted. Seventy-three percent were male
patients and 78% Caucasian; mean age was 13 6 3.5 years. ED
visits for sports-related TBIs increased 92% over the study period,
yet there was no significant change (x2= 9.8, df = 9, P = .37) in the
percentage of children admitted. Mean injury severity score for those
admitted decreased from 7.8 to 4.8 (b = –0.46; P = .006); length of stay
trended downward (b = –0.05; P = .05).
CONCLUSIONS: The percentage of children being admitted from the ED
with sports-related TBI has not changed over the past 10 years. The
severity of admitted sports-related TBI is decreasing. Additional
research is needed to correlate these trends with other TBI
mechanisms. Pediatrics 2013;132:e859–e864
AUTHORS: Holly R. Hanson, MD, Wendy J. Pomerantz, MD,
MS, and Mike Gittelman, MD
Division of Emergency Medicine, Cincinnati Children’s Hospital
Medical Center, Cincinnati, Ohio
traumatic brain injury, sports, pediatrics, admission, severity
CCHMC—Cincinnati Children’s Hospital Medical Center
CDC—Centers for Disease Control and Prevention
ICD-9—International Classification of Diseases, Ninth Revision
ISS—injury severity score
LOS—length of stay
TBI—traumatic brain injury
Dr Hanson conceptualized and designed the study and drafted
the initial manuscript; Dr Pomerantz was involved in the initial
study designs, was responsible for the data analysis, and
reviewed and revised the manuscript; Dr Gittelman was involved
in the initial study design and critically reviewed and revised the
manuscript; and all authors approved the final manuscript as
Accepted for publication Jul 24, 2013
Address correspondence to Holly Hanson, MD, Division of
Emergency Medicine, Cincinnati Children’s Hospital Medical
Center, 3333 Burnet Ave, MLC 2008 Cincinnati, OH 45229. E-mail:
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2013 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated
they have no potential conflicts of interest to disclose.
PEDIATRICS Volume 132, Number 4, October 2013
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