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Somewhere over the rainbow… Concussion care

Somewhere over the rainbow… Concussion care. MBIA Conference April 11,2013 Leslie Seymour, MD, MPH; Jon Roesler, MS Anna Gaichas, MA; Mark Kinde, MPH. I. Background A. Problem in Minnesota B. Need for new way of tracking C. Committee formed II. Creation of online reporting system

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Somewhere over the rainbow… Concussion care

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  1. Somewhere over the rainbow…Concussion care MBIA Conference April 11,2013 Leslie Seymour, MD, MPH; Jon Roesler, MS Anna Gaichas, MA; Mark Kinde, MPH

  2. I. Background A. Problem in Minnesota B. Need for new way of tracking C. Committee formed II. Creation of online reporting system A. Concerns B. Technical Development C. Pilot program D. Issues encountered III. Results to Date IV. Future A. Expansion of system B. Assessing long-term outcomes

  3. Background

  4. Concussion “Any trauma induced alteration in mental status that may or may not include a loss of consciousness.”

  5. 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

  6. Problem in Minnesota2002-2011 N Data from Minnesota State TBI Registry Issue: Hospitalized patients only

  7. Sport & Rec ConcussionsMinnesota, 2002-2011, Ages 5-19 N Data from the Minnesota Hospital Association Issue: Identification of sport and recreation

  8. 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

  9. Cause of Concussions Minnesota, 2002-2011, All Ages N

  10. Cause by age-groupMN 2002-2011 N 55% Age group

  11. 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

  12. 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

  13. Creation of online reporting system • Concerns • Technical Development • Pilot program • Issues Encountered

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

  15. 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?

  16. Demographic Data

  17. Signs/Symptoms

  18. Academic Information

  19. Pilot • Schools with Fairview AT • Recruited school contact • Initial Paper reporting • Transitioned to Electronic

  20. 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!!!!!

  21. Prelim Results • Concussions by gender • Concussions by sports and gender • Concussions by type of event • Athletes missing school

  22. Percent of Concussions by Gender Percent Sports Included: Basketball, Football, Hockey, Soccer, Volleyball, Wrestling

  23. Concussions by Sport & GenderMinnesota, 2012-13, Pilot System Preliminary FindingsRates Rate* *Rates are per 100 participants

  24. Concussions by Type of Event Rate* *Rates are per 100 events

  25. Number/Percent Athletes that Missed any School N Missed School

  26. School Missed 87% N N=2 <1% Days of School Missed

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

  28. Future • Maintaining and/or Expanding System? • ????Longitudinal Follow-up???? • (most kids have ok outcomes) • Repeat concussions • Time lag between concussions • Societal acceptance of concussions

  29. System Expansion Can we take it statewide?

  30. 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?

  31. Contact Information Leslie Seymour, MD, MPH Phone: 651-201-5489 Email: leslie.seymour@state.mn.us

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