@article{85eec8000d3d493d80abc7fa0ec3a880,
title = "Patient presentations in outpatient settings: Epidemiology of adult head trauma treated outside of hospital emergency departments",
abstract = "Background: While deaths, hospitalizations, and emergency department visits for head trauma are well understood, little is known about presentations in outpatient settings. Our objective was to examine the epidemiology and extent of healthcare-seeking adult (18-64 years) head trauma patients presenting in outpatient settings compared with patients receiving nonhospitalized emergency department care. Methods: We used 2004-2013 MarketScan Medicaid/commercial claims to identify head trauma patients managed in outpatient settings (primary care provider, urgent care) and the emergency department. We examined differences in demographic and injury-specific factors, Centers for Disease Control and Prevention-defined head trauma diagnoses, and extent of and reasons for postindex visit ambulatory care use within 30/90/180 days by index visit location, as well as annual and monthly variations in head trauma trends. We used outpatient incidence rates to estimate the US nationwide outpatient burden. Results: A total of 1.19 million index outpatient visits were included (emergency department: 348,659). Nationwide, they represented a weighted annual burden of 1.16 million index outpatient cases. These encompassed 46% of all known healthcare-seeking head trauma in 2013 (outpatient/emergency department/inpatient/fatalities) and increased in magnitude (+31%) from 2004 to 2013. One fourth (27%) of office/clinic visits led to diagnosis with concussion on index presentation (urgent care: 32%). Distributions of demographic factors varied with index visit location while injury-specific factors were largely comparable. Subsequent visits reflected high demand for follow-up treatment, increased concussive diagnoses, and sequelae-associated care. Conclusions: Adult outpatient presentations of head trauma remain poorly understood. The results of this study demonstrate the extensive magnitude of their occurrence and close association with need for follow-up care.",
keywords = "Ambulatory, Concussion, Head trauma, Outpatient, Traumatic brain injury",
author = "Zogg, {Cheryl K.} and {Sterling Haring}, R. and Likang Xu and Canner, {Joseph K.} and Ottesen, {Taylor D.} and Ali Salim and Haider, {Adil H.} and Schneider, {Eric B.}",
note = "Funding Information: No funding specifically for this work was provided. C.K.Z. is supported by National Institutes of Health Medical Scientist Training Program Training Grant T32GM007205. A.H.H. is the Primary Investigator of a contract (AD-1306–03980) with PCORI entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED,” a Harvard Surgery Affinity Research Collaborative (ARC) Program Grant entitled “Mitigating Dispari-ties Through Enhancing Surgeons{\textquoteright} Ability To Provide Culturally Relevant Care,” and a collaborative research grant from the Henry M. Jackson Foun-dation for the Advancement of Military Medicine in conjunction with the Uniformed Services University of the Health Sciences entitled “The Com-parative Effectiveness and Provider Induced Demand Collaboration.” A.H.H. is also a co-founder and equity-shareholder of the company Patient Doctor Technologies, Inc., which owns and operates the website www.doctella.com. Funding Information: No funding specifically for this work was provided. C.K.Z. is supported by National Institutes of Health Medical Scientist Training Program Training Grant T32GM007205. A.H.H. is the Primary Investigator of a contract (AD-1306-03980) with PCORI entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED,” a Harvard Surgery Affinity Research Collaborative (ARC) Program Grant entitled “Mitigating Disparities Through Enhancing Surgeons' Ability To Provide Culturally Relevant Care,” and a collaborative research grant from the Henry M. Jackson Foundation for the Advancement of Military Medicine in conjunction with the Uniformed Services University of the Health Sciences entitled “The Comparative Effectiveness and Provider Induced Demand Collaboration.” A.H.H. is also a co-founder and equity-shareholder of the company Patient Doctor Technologies, Inc., which owns and operates the website www.doctella.com. Publisher Copyright: Copyright {\textcopyright} 2018 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2018",
doi = "10.1097/EDE.0000000000000900",
language = "English",
volume = "29",
pages = "885--894",
journal = "Epidemiology",
issn = "1044-3983",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "6",
}