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Medical Care Among Individuals with a Concussion in Ontario: A Population-based Study

Published online by Cambridge University Press:  20 December 2022

Laura Kathleen Langer Open the ORCID record for Laura Kathleen Langer [Opens in a new window] ,
Mark Thedore Bayley ,
Charissa Levy ,
Sarah Elizabeth Patricia Munce ,
David Wyndham Lawrence Open the ORCID record for David Wyndham Lawrence [Opens in a new window] ,
Alan Tam  and
Claire de Oliveira
Laura Kathleen Langer*
Affiliation:
KITE Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
Mark Thedore Bayley
Affiliation:
KITE Toronto Rehabilitation Institute – University Health Network, Toronto, Canada Toronto Rehabilitation Institute – University Health Network, Toronto, Canada Faculty of Medicine, University of Toronto, Toronto, Canada Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ICES, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Charissa Levy
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Toronto ABI Network, Toronto, Canada
Sarah Elizabeth Patricia Munce
Affiliation:
KITE Toronto Rehabilitation Institute – University Health Network, Toronto, Canada Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
David Wyndham Lawrence
Affiliation:
Toronto Rehabilitation Institute – University Health Network, Toronto, Canada Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada Mt Sinai Hospital, New York, USA
Alan Tam
Affiliation:
Toronto Rehabilitation Institute – University Health Network, Toronto, Canada Faculty of Medicine, University of Toronto, Toronto, Canada
Claire de Oliveira
Affiliation:
ICES, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada Centre for Health Economics and Hull York Medical School, University of York, UK
*
Corresponding author: Laura Langer, KITE Toronto Rehabilitation Institute – University Health Network, Toronto, Canada. Email: laura.langer@uhn.ca
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Abstract:

Background:

Concussion affects 1.2% of the population annually; rural regions and children have higher rates of concussion.

Methods:

Using administrative health care linked databases, all residents of Ontario with a physician diagnosed concussion were identified using ICD-9 code 850 or ICD-10 code S06. Cases were tracked for 2 years for concussion-related health care utilization with relevant specialist physicians (i.e., neurology, otolaryngology, physiatry, psychiatry, ophthalmology). Billing codes, specialist codes, and time from index to visit were analyzed. Factors associated with increased specialist visits were also examined.

Results:

In total, 1,022,588 cases were identified between 2008 and 2014 with 2 years of post-concussion health care utilization available. Follow-up by physician within 3 days of injury occurred in only 14% of cases. Mean time between ED diagnosis and follow-up by a physician was 83.9 days, whereas for rural regions it was >100 days. About half of adults (51.9%) and children (50.3%) had at least 1 specialist visit following concussion. Mean time between injury and first specialist visit was 203.8 (SD 192.9) days for adults, 213.5 (SD 201.0) days for rural adults, and 276.0 (SD 202.6) days for children. There were 67,420 neurology visits, 70,404 psychiatry visits, 13,571 neurosurgery visits, 19,780 physiatry visits, 101,788 ENT visits, and 103,417 ophthalmology visits in the 2 years tracking period. Factors associated with more specialist use included age > 18 years, urban residence, and pre-injury psychiatric history.

Conclusions:

There are discrepancies in post-concussion health care utilization based on age group and rural/urban residence. Addressing these risk factors could improve concussion care access.

Résumé :

RÉSUMÉ :

L’utilisation des soins médicaux après une commotion cérébrale, en Ontario : étude fondée sur la population.

Contexte :

Les commotions cérébrales frappent chaque année 1,2 % de la population, plus particulièrement en milieu rural et chez les enfants.

Méthode :

Une recherche à l’aide de bases de données administratives liées sur la prestation des soins de santé a permis de repérer tous les patients demeurant en Ontario chez qui un diagnostic de commotion, correspondant aux codes 850 selon l’ICM9 ou S06 selon l’ICM10, a été posé par un médecin. Les cas ont fait l’objet d’un suivi de 2 ans quant à l’utilisation des soins de santé en lien avec la commotion chez des spécialistes dans des domaines appropriés (c.-à-d. neurologie, otorhinolaryngologie [ORL], physiatrie, psychiatrie, ophtalmologie). Il y a eu analyse des codes de facturation, des codes de spécialité et du temps écoulé entre le moment de l’accident et la consultation, de même que des facteurs associés à un nombre accru de consultations chez des spécialistes.

Résultats :

Il existait des données de suivi sur l’utilisation des soins de santé après une commotion, sur la période de 2 ans, dans 1 022 588 cas, entre 2008 et 2014. Un suivi médical a été réalisé dans les 3 jours suivant l’accident dans 14 % des cas seulement. Le temps moyen écoulé entre le moment de la pose du diagnostic au service des urgences et le suivi médical était de 83,9 jours; en milieu rural, il était supérieur à 100 jours. Après la commotion, environ la moitié des adultes (51,9 %) et la moitié des enfants (50,3 %) ont consulté un spécialiste au moins une fois. Quant au temps moyen écoulé entre le moment de l’accident et la première consultation d’un spécialiste, il était de 203,8 jours (écart type [σ] : 192,9) chez les adultes; de 213,5 jours (σ : 201,0) chez les adultes en milieu rural et de 276,0 jours (σ : 202,6) chez les enfants. Ont été relevées dans l’ensemble 67 420 consultations en neurologie; 70 404, en psychiatrie; 13 571, en neurochirurgie; 19 780, en physiatrie; 101 788, en ORL et 103 417, en ophtalmologie, sur la période de suivi de 2 ans. Parmi les facteurs associés à un nombre plus élevé de consultations de spécialistes figuraient un âge supérieur à 18 ans, le milieu de vie urbain et des antécédents de troubles psychiatriques avant la survenue de l’accident.

Conclusion :

Des écarts ont été relevés entre l’utilisation des soins de santé après une commotion et les tranches d’âge ainsi que les milieux de vie urbain et rural. Le fait de porter une attention particulière à ces facteurs de risque pourrait faciliter l’accès aux soins de santé après une commotion.

Keywords

ConcussionPediatric concussionAdult concussionAdministrative health dataHealth system analysisRural-urban linkages
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 51 , Issue 1 , January 2024 , pp. 87 - 97
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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