Factors Influencing Primary Care Follow-Up After Pediatric Mild Traumatic Brain Injury.
Dustin Currie, Traci Snedden, Lauren Pierpoint and 2 others
PMID 30608309WHAT IT FOUND
Girls and caregivers who believed concussion was serious and needed follow-up were more likely to attend a primary care visit after discharge.
Insurance and having a named doctor did not predict attendance.
Key findings
01Female sex and caregiver attitudes were the variables retained in the final model as associated with attending follow-up.
02Insurance, having a specific primary care provider, reviewing discharge instructions, and injury characteristics were not associated with follow-up attendance.
03Children who had already scheduled a primary care appointment by the early follow-up call were more likely to attend later, and caregivers who had not scheduled often said the child did not need an appointment.
STILL TO COME
How it was doneWhat they found
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What it does not show
Attrition was 18.3%, and families who completed the 30-day call were more likely to have had a sport-related injury or a prior mental health diagnosis than those lost to follow-up. The study used a convenience sample from a single major metropolitan emergency department, so results may not apply to other regions or populations. Families were already able to obtain emergency care, which may make insurance and access barriers less visible. Primary care attendance was caregiver self-report and was not verified with primary care records. The caregiver attitude survey was created for this study and has not been formally validated for accuracy. The 7-day call asked about scheduling and may have prompted some families to schedule an appointment.
Declared interests
The authors declared no relevant conflicts of interest. The article is listed as supported by NIH extramural research and non-U.S. government research.
The easy way to misread this
Do not conclude that lack of insurance or no named primary care provider explains poor follow-up; those factors were not associated in this cohort. Do not treat caregiver attitudes as a proven cause of follow-up; this was an observational association study with self-reported attendance.