SOMEWHERE OVER THE RAINBOW…

CONCUSSION CARE

MBIA ConferenceApril 11,2013

Leslie Seymour, MD, MPH; Jon Roesler, MSAnna Gaichas, MA; Mark Kinde, MPH

I. BackgroundA. Problem in MinnesotaB. Need for new way of trackingC. Committee formed

II. Creation of online reporting system

A. ConcernsB. Technical DevelopmentC. Pilot programD. Issues encountered

III. Results to Date

IV. FutureA. Expansion of systemB. Assessing long-term outcomes

 

Background

Concussion

“Any trauma induced alteration in mental status that may or may not include a loss

of consciousness.”

National Data

~ 300,000 sport-related TBI’s per year Leading Causes (in order):

football girls’ soccer boy’s soccer girls’ basketball

Concussion rate higher in competition vs. practice

Problem in Minnesota2002-2011

N

Data from Minnesota State TBI RegistryIssue: Hospitalized patients only

Sport & Rec ConcussionsMinnesota, 2002-2011, Ages 5-

19

Data from the Minnesota Hospital Association

Issue: Identification of sport and recreation

N

Sport vs. Recreation

Sport Place for recreation

and sport From jumping or

diving into pool Fall from skis Fall in sports Struck by or

against in sport

Recreation ATV or snowmobile Watercraft related Unpowered aircraft Fall from playground

equipment Fall from scooter, roller

skates, or snowboard Fireworks Drowning from

sport/rec Air-gun or paintball gun

MHA Data

Cause of Concussions Minnesota, 2002-2011, All Ages

N

Cause by age-groupMN 2002-2011

55%

N

Age group

Need for new data collection system

To more accurately understand the nature of the problem in Minnesota, of Sports Related Concussion in youth.

Registry captures hospitalized cases only. Billing data does not provide sufficient

identification of the sport involved. Current data does not capture:

- those treated by AT only- those seen in urgent care- those seen by their own family

physicians

Vast majority of cases

Sports-related Concussion Committee

2 physician’s with large patient loads of SRC

Athletic trainer who oversees high school athletic trainers from the Fairview Health System

A representative from the MSHSL A representative from the MN Department

of Education A nurse from Gillette Hospital’s pediatric

TBI rehabilitation unit A representative from MBIA

Creation of online reporting system

Concerns Technical Development Pilot program Issues Encountered

Concerns

Privacy! Information to collect Who Reports / Burden of Reporting Timely Accurate Complete Statutory Authority Action (So What? / Now What?)

Technical Development

System modeled after RIO Not as extensive Addition of some academic impact questions

In-house programmers (# of hours?) Systems Analyst Web Developer

Who will pilot?

Demographic Data

Signs/Symptoms

Academic Information

Pilot

Schools with Fairview AT Recruited school contact Initial Paper reporting Transitioned to Electronic

Issues

Principals did not respond Some schools chose not to participate in

academic portion Privacy (Education data vs health data) Users accessing SRCRS Time-lag Loss of dedicated CDC funding!!!!!

Prelim Results

Concussions by gender Concussions by sports and gender Concussions by type of event Athletes missing school

Percent of Concussions by Gender

Percent

Sports Included: Basketball, Football, Hockey, Soccer, Volleyball, Wrestling

Concussions by Sport & GenderMinnesota, 2012-13, Pilot System Preliminary Findings

Rates

*Rates are per 100 participants

Rate

*

Concussions by Type of Event

Rate*

*Rates are per 100 events

Number/Percent Athletes that Missed any School

N

Missed School

School Missed

N=2

<1%

87%

N

Days of School Missed

Issues

Small N’s Reporting Bias of AT’s Student doesn’t report Data awaits validation Difficulty getting academic reporters

Future

Maintaining and/or Expanding System? ????Longitudinal Follow-up????

(most kids have ok outcomes) Repeat concussions Time lag between concussions

Societal acceptance of concussions

System Expansion

Can we take it statewide?

Longitudinal Follow-upThe End of the Rainbow

Is the return to play protocol being followed? Are schools making proper accommodations? What about Resource Facilitation referrals?

When? After multiple repeat concussions? Symptomatic for an extended period – how long?

How? Brochure, letter, phone call? Who: AT’s, Academic contacts, Principals?

Contact Information

Leslie Seymour, MD, MPHPhone: 651-201-5489

Email: leslie.seymour@state.mn.us