Concussion legislation yields higher healthcare utilization, but not more imaging

State legislation has played a role in boosting overall healthcare utilization rates in children with concussions, though the laws have done little to change CT scan rates specifically, according to a study published online Dec. 22 in JAMA Pediatrics.

Citing rates between 1.6 and 3.8 million athletics-related concussions per year, the research team, along with lead author Teresa B. Gibson, PhD., of Truven Health Analytics, wanted to evaluate the impact new state-based concussion legislation had, as these new laws were the first legal guidelines mandating medical intervention before returning to play.

The team looked at commercially insured children from 12 to 18 years old from states with and without concussion legislation a concussion diagnosis. They looked at utilization rates before (between 2006 and 2009) and after concussion legislation and the effect that state concussion laws had on trends.

“During the previous decade, there has been a growing interest in the management of concussions, and beginning July 1, 2009, every state has enacted treatment legislation for the injury,” the authors wrote. “This investigation sought to evaluate how legislative action and overall concussion awareness have altered utilization of medical services.”

Gibson and colleagues found that between academic years 2008-09 and 2011-12, states that had concussion legislation had a 92 percent concussion-related healthcare utilization. Additionally, states without concussion legislation saw a 75 percent increase in healthcare utilization between the two school years.

The team found the trends in emergency department visits and CT scans were relatively unchanged between the period before concussion legislation and after—with the growth rate staying at 7 percent.

“Similarly, ED visit and CT scan rates were no different in states with and without laws in effect,” they wrote.

Repeated injury is a major concern for providers, and the authors cited an earlier study that found that more than 90 percent of individuals who received a repeat injury received it within 10 days of the concussion.

“Although it was beyond the scope of this investigation to evaluate the effects of state legislation on repeated concussions, we would expect that the increased use of physicians through office (78 percent increase) and neurologist (150 percent increase) visits has resulted in better management and longer recovery times before returning to participation,” Gibson and colleagues wrote. “Encouragingly, the rate of concussions managed through the ED remained unchanged following the implementation of state laws, suggesting that those who seek medical care for the injury are doing so through the appropriate channels.”