The Financial Cost of Concussions
Each year, over 1 million visits are made to the emergency department for traumatic brain injury (TBI), and about 75% of those injuries are concussions or other forms of mild TBI1. According to the CDC, 65% of all concussion patients are between the ages of 5 and 18. While mild brain injuries or concussions can have a significant long-term effect on patient and society1 , many with mild TBI are being subject to unnecessary imaging and/or hospitalization.
A review of data from the National Inpatient Sample, which is the largest all-payer inpatient care database in the USA, was performed to assess characteristics associated with hospitalizations for sport-related concussions. The review included data from 2000 to 2004 on patients age 5 to 18 and showed that there were over 3700 hospital admissions during this time secondary to sport-related concussions. This resulted in over $29 million in hospital charges, or almost $6 million per year. The study also suggested that non-teaching hospitals and rural hospitals were more likely to admit young patients with concussions.2
Another review of data from US emergency departments in the years 2002-2006 was performed to assess the incidence of imaging in patients age 5 to 19 who presented with concussion. Eighteen percent of all pediatric emergency department visits were secondary to concussion, and 69 percent of these patients received imaging.3
It is important for clinicians to know that concussion involves a functional disturbance of the brain, rather than structural damage. Standard imaging, such as CT or MRI, rarely contributes to the diagnosis or prognosis of a concussion patient. New imaging modalities such as diffusion tensor imaging (DTI) or functional MRI (fMRI) are being explored for potential diagnostic and/or prognostic value, but more information is needed before they are regularly utilized. Currently, the recommendation is that imaging should only be considered if there is suspicion for intracranial pathology, which would be indicated by prolonged unconsciousness, vomiting, focal neurologic deficit, worsening symptoms, or deterioration of clinical status or conscious state. Additionally, the loss of consciousness itself is not an indication for transport to the hospital. There is no indication for hospitalization in the case of concussion in the recent guidelines.4 Adherence to the guidelines can lead to more cost-effective evaluations of concussions in all settings.