Healthcare utilization in the first year after pediatric traumatic brain injury in an insured population.

ABSTRACT

OBJECTIVE: To compare the healthcare use by children with and without a traumatic brain injury (TBI) in the year following injury to understand whether children access primary care. PARTICIPANTS: Children 0 to 15 years with a TBI (N = 545) and (N = 2310) uninjured age and sex-matched comparisons. SETTING: A full benefits healthcare plan from 2000 to 2007. MAIN MEASURES: Mean annual healthcare utilization. RESULTS: Children with TBI had higher mean annual outpatient visits (4.2 vs. 3.5, P = .001), but similar mean annual general pediatric visits (2.7 vs. 2.8, P = .3) than comparison children. More cases than comparisons attended a general pediatric visit (80.0% vs. 73.3%, risk ratio = 1.1, 95% CI 1.0-1.1). However, approximately 50% of children older than 7 years who had an intracranial injury did not attend a general pediatric visit and those were slightly more likely to receive specialty care (adjusted risk ratio = 1.1, 95% CI 1.0-1.2). These children did not appear to be substituting specialty for primary care. CONCLUSIONS: Children with a full benefits insurance plan do not access primary care routinely after TBI. These findings present a challenge for designing a system to screen children after TBI.