Youth Sport Related Concussion Study FINAL
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Transcript of Youth Sport Related Concussion Study FINAL
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1ED and Hospital Admission Rates for Youth Sport Related Concussions
(c) Copyright (October 20, 2011) All Rights Reserved
Emergency Department and Hospital Admission Ratesfor Youth Sports-Related Concussions:A Northeast Florida Utilization Study
ContentsTables and Figures p. 2
About the Health Planning Council p. 4Background p. 4
Literature Review p. 5
Research Questions p. 7
Data Collection p. 7
Findings p. 8
National p. 9
State p. 11
Regional p. 13
Recommendations p. 36
References p. 37
A Smart People Project
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2ED and Hospital Admission Rates for Youth Sport Related Concussions
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Tables and Figures
ble 1 Top 20 Sports/Recreational Activities that Lead to Head Injuries----------------------------------------------------------6ble 2 Top 10 Sports-Related Head Injury Categories Among Children Ages 14 and Younger------------------------6ble 3 Numbers and age-adjusted rates per 100,000 population for traumatic brain
injury deaths, by year, sex, and race/ethnicity 19972007------------------------------------------------------------------- 9gure 1 Age-Adjusted Rate of Traumatic Brain Injury Deaths (All Ages) By Race 1997-2007--------------------------1gure 2 Age-Adjusted Rate of Traumatic Brain Injury Deaths (All Ages) By Gender 1997-2007----------------------10gure 3 Age-Adjusted Rate of Traumatic Brain Injury Deaths By Age 1997-2007---------------------------------------------1ble 4 The number and rate of Traumatic Brain Injury-Related Deaths by Age Group, Florida
1997-2007________________________________________________________________________11gure 4 Non-Fatal Head Injury Hospitalization for Ages 12-18, Florida Department of Health,
1999-2009------------------------------------------------------------------------------------------------------------------------------------------------ 12gure 5 Emergency Department Visits, Patients with TBI versus Non-TBI, 2006-2009------------------------------------1gure 6 Emergency Department Visits for Patients with TBI, Sports versus Non-Sports
Related, 2006-2009---------------------------------------------------------------------------------------------------------------------------------14gure 7 Emergency Department Visits for Patients with TBI, Sports versus Non-Sports
Related, By Age, 2006-2009--------------------------------------------------------------------------------------------------------------------1ble 5 Emergency Department Visits for Patients with TBI, Sports Versus Non-Sports
Related, By Age, 2006-2009 Percentage of TBI Visits that are Sports-Related-----------------------------------1gure 8 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By Gender, 2006-2009--------------------------------------------------------------------------------------------------------------1gure 9 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By Race, 2006-2009------------------------------------------------------------------------------------------------------------------1gure 10 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By Payor, 2006-2009-----------------------------------------------------------------------------------------------------------------1ble 6 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By Payor, 2006-2009 Percentage of TBI Visits that are Sports-Related--------------------------------1gure 11 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By County, 2006-2009--------------------------------------------------------------------------------------------------------------19ble 7 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By County, 2006-2009 Percentage of TBI Visits that are Sports-Related-----------------------------19gure 12 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By Day of the Week, 2006-2009----------------------------------------------------------------------------------------------20ble 8 Emergency Department Visits for Patients with TBI, Sports and Non-Sports Related,
By Day of the Week, 2006-2009 Percentage of TBI Visits that are Sports-Related----------------------------20gure 13 Emergency Department Visits for Patients with TBI, Sports and Non-Sports
Related, By Hospital, 2006-2009------------------------------------------------------------------------------------------------------------21ble 9 Emergency Department Visits for Patients with TBI, Sports and Non-Sports Related,
By Hospital, 2006-2009 Percentage of TBI Visits that are Sports-Related------------------------------------------21gure 14 Emergency Department Percentage of Visits Receiving a CT Scan for TBI
Sports and Non-Sports Related, 2006-2009----------------------------------------------------------------------------------------- 22gure 15 Hospital Admissions for Patients with TBI and Non-TBI, 2006-2009--------------------------------------------------- 2gure 16 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,2006-2009----------------------------------------------------------------------------------------------------------------------------------------------- 24gure 17 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Age, 2006-2009----------------------------------------------------------------------------------------------------------------------------------25ble 10 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Age, 2006-2009 Percentage of TBI Visits that are Sports-Related-------------------------------------------------25gure 18 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Gender, 2006-2009----------------------------------------------------------------------------------------------------------------------------26ble 11 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
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3ED and Hospital Admission Rates for Youth Sport Related Concussions
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By Gender, 2006-2009, Percentage of TBI, ED and Hospitalizations, by Gender_______________ 26gure 19 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Race, 2006-2009--------------------------------------------------------------------------------------------------------------------------------27gure 20 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Payor, 2006-2009------------------------------------------------------------------------------------------------------------------------------- 2ble 12 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Payor, 2006-2009 Percentage of TBI Visits that are Sports-Related-----------------------------------------------2gure 21 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By County, 2006-2009------------------------------------------------------------------------------------------------------------------------------2ble 13 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By County, 2006-2009 Percentage of TBI Visits that are Sports-Related---------------------------------------------2gure 22 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Day of the Week, 2006-2009--------------------------------------------------------------------------------------------------------------3ble 14 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Day of the Week, 2006-2009 Percentage of TBI Visits that are Sports-Related-----------------------------3gure 23 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Hospital, 2006-2009----------------------------------------------------------------------------------------------------------------------------3ble 15 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
By Hospital, 2006-2009 Percentage of TBI Visits that are Sports-Related-------------------------------------------3gure 24 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
Mean LOS, 2006-2009-----------------------------------------------------------------------------------------------------------------------------3gure 25 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
Mean Gross Charges, 2006-2009-----------------------------------------------------------------------------------------------------------33gure 26 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
Discharge Status, 2006-2009-----------------------------------------------------------------------------------------------------------------34gure 27 Hospital Admissions for Patients with TBI Sports and Non-Sports Related,
Admission Type, 2006-2009--------------------------------------------------------------------------------------------------------------------3
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4ED and Hospital Admission Rates for Youth Sport Related Concussions
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bout the Healthlanning CouncilThe Health Planning Council is a non-
profit agency and one of 11 Local
Planning Councils mandated by Florida
State Statute 408.033 to dedicate
resources and expertise to regional
community-based health needsassessments, healthcare utilization
studies, management of health-related
quality of life indicators and the
development of effective collaborative
partnerships. For over 40 years, weve
been making the region healthier by
providing assessment services to our
service delivery area: Baker, Clay,
Duval, Flagler, Nassau, St. Johns and
Volusia Counties. As a neutral regional
planning entity with offices in both
Duval and Volusia Counties, we
provide a range of health planning
expertise without bias or conflicts of
interest. We serve the region by
actively participating and influencing
outcomes to protect and create
healthy, sustainable communities.
Our core focus areas address:Healthy Communities- Assessprevalence of disease and issues
impacted by biological, behavioral,
social and environmental
determinants of healthHappy and Healthy Places-Influence policy that improves
quality of life and the built
environmentSmart People-Equip decision-makers and the public with the
information they need to make
informed decisionsVibrant Partnerships-Develop andleverage effective collaborations,
networks, systems & health-
related organizations
ackgroundIn October 2010, the Health Planning
Council announced the topic for the
2011 Utilization Study: The Youth
Sport-Related Concussion Study.
After selecting the topic, the Health
Planning Council worked on
assembling and convening a group
of regional representatives from
area hospitals and sport-related
organizations to form the study
council. The study council would be
charged with determining the
research questions, collecting and
analyzing the local data, and making
formal recommendations. The
group consists of representatives
from Agency for Health Care
Administration (AHCA), Baker County
Hospital Authority, Baptist
Health,Brooks Rehabilitation, Duval
County Medical Society, the Florida
Association of High School Athletics,
Florida Hospital, Halifax Medical
Center, Jacksonville Jaguars,
Jacksonville Sports Medicine
Program, Mayo Clinic, MemorialHealth, Nemours Childrens Clinic,
Office of Research Affairs Center for
Healthy Equity and Quality Research
UF-Shands, Orange Park Medical
Center, Shands Jacksonville, St.
Vincents Health, Wolfson Childrens
Hospital, the University of North
Florida, the University of Florida
Emergency Department in
Jacksonville, and a local neuro-
psychologist.
The study council developed the
following areas of concern regarding
sport-related concussions in children
between the ages of 10-18:
The need to ensure children
safety during sport activities. The
disconnect among community
stakeholders regarding local
expertise and stewardship,
outreach efforts, education,
clinical research, reporting,
treatment, neuro-imaging,
etcregarding sport related
concussion in children
Communities have a difficult
time identifying and
understanding valid,
quantifiable, baseline data for
incidence and prevalence of
youth sport related concussions
The absence of a formalized
process for reporting youth-rela
concussions, which occurs in
community sports associations
and schools
The vital need to educate the
community on how to tell when
head injury has occurred (terme
signs and symptoms), treatme
and follow up procedures for yo
sport concussions- i.e. coaches
hospital staff, parents,
pediatricians, students and
athletic trainers
Concussions are difficult to
diagnose; There are hidden sign
and symptoms are often
misdiagnosed or completely
overlooked and missed
Concussion treatment, hospital
discharge procedures, andensuring appropriate follow up a
challenges for ED physicians,
primary care physicians,
pediatricians, parents, and
coaches
The need to better understand t
long-term outcomes of the 1st
subsequent concussive episode
1, 2, 3 years post concussion
including school performance
The community needs to develo
and agree to the ethicalconsiderations for allowing
children to return to play after a
concussion to avoid significant
health consequences and death
There is a need to better
understand the indications for
utilizing CT scans or other imag
procedures in the management
children with minor injury with o
without symptoms of concussio
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5ED and Hospital Admission Rates for Youth Sport Related Concussions
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he Health Planning Council assembled 23 peer reviewed articles to assist with selecting initial research questions. The
rticles were plotted on a matrix to classify the information for further analysis. Many of the articles were dated within in
he last 10 years and related to head injuries, concussions caused by sports, CT (computed tomographic) scan utilization
nd signs and symptoms. The Health Planning Council looked to the expertise of the Study Council to finalize the resear
uestions for the study.
port-related traumatic brain injuries (TBIs) have received an increase in national and local attention over the last severa
ears with state and federal governments leading the implementation of laws directing a set of standards and guidelines
uspected brain injury (Centers for Disease Control and Prevention, 2011) . This is evident by the 60% increase in the
ediatric ED visits of concussion over the last 8 years. The recommendations from the Third International Conference on
Concussion in Sports were to reinforce an individualized evaluation of an athletes neurocognitive functioning, symptoms
nd balance and a step wise approach in the return to play process. There is also a need for a standardized and objectiv
ool to aid in the initial evaluation and management of brain injuries (Cohen, Gioia, Atabaki, & Teach, 2009). Despite the
eed for a standard grading scale to determine the severity of the head injury, it is important to determine return to plaased on a clinical evaluation of the individual athlete (Collie, McCrory, Makdissi, 2006). Substantial knowledge now exis
hat will help in evaluating an injured athlete and the most appropriate management scheme in order to prevent perman
erebral dysfunction and to establish return to play guidelines (Bailes & Hudson, 2001).
Often times players will suffer from a head injury and never report it. Players and coaches need to be educated on the s
nd symptoms of head injuries as well as proper care procedures. Having a certified athletic trainer at high school sport
vents would greatly aide in the proper diagnosis and treatment of head injuries during these events. It is also vital for t
oaches and athletic trainers to agree upon what concussion grading scale and return to play guidelines will be used
American Academy of Neurology, Colorado Medical Society, Cantu) (Logan, Bell, & Leonardt, 2001). Often times when a
atient doesnt fully understand concussions, they will continue to participate in high risk activities despite having
ymptoms of a concussion. This can lead to further concussions and Second Impact Syndrome (Delaney, Abuzeyad, Cor
& Foxford, 2005).
ven though the actual number of head injuries varies between ice hockey, football and soccer, the annual rate for each
port is comparable (Delaney, 2004). Females sustained a higher rate of concussions than males during sport related
ctivities (Covassin, Swanik, & Sachs, 2003). Concussion rates tend to be higher among collegiate athletes but they
epresent a high proportion of the injuries reported in high school athletes (Gessel, Fields, Collins, Dick, & Cornstock, 200
atients presenting to the emergency department (ED) because of a head injury from a sport-related activity are commo
nd are typicallymore severe than other types of sport related injuries treated in the ED (Kelly, Lissel, Rowe, Vincenten, &oaklander, 2001). Concussion injury is 6 times more likely to happen during organized sports activity than in other
ctivities for children ages 6 to 14 (Lovell & Fazio, 2008).
Hospital stays for patients with a traumatic brain injury (TBI) tend to be longer and more costly than hospitalizations for nBI injuries. TBI hospitalizations are also more likely to occur among younger patients and males. Patients admitted for
lso have a higher in-hospital death rate than other injuries(Russo & Steiner, 2007).The American Association ofNeurological Surgeons reports that the leading cause of death from sports-related injuries is TBI. They define TBI as a b
r jolt to the head or a penetrating head injury that disrupts the normal function of the brain. According to an AANS stud
hat utilized Consumer Product Safety Commission (CPSC) data, 446,788 sports-related head injuries were treated in U.S
mergency departments in 2009. The actual incidence of these injuries could in fact be larger due to the exclusion of da
or product categories with 1,200 injuries or less. Additionally, not all head injuries are treated in emergency department
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6ED and Hospital Admission Rates for Youth Sport Related Concussions
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Table 2
The following 20 sports/recreational activities represent the categories contributing to the
highest number of estimated head injuries treated in U.S. hospital emergency rooms in 2009 (All ages).
Source: American Association of Neurological SurgeonsThe top 10 sports-related head injury categories among children ages 14 and younger:
Source: American Association of Neurological Surgeons
Sport Estimated Number ofHead InjuriesCycling 85,389
Football 46,948
Baseball and Softball 38,394
Basketball 34,692
Water Sports (Diving, Scuba Diving, Surfing, Swimming, Water Polo, Water Skiing,
Water Tubing)
28,716
Powered Recreational Vehicles (ATVs, Dune Buggies, Go-Carts, Mini bikes, Off-road) 26,606
Soccer 24,184
Skateboards/Scooters 23,114
Fitness/Exercise/Health Club 18,012
Winter Sports (Skiing, Sledding, Snowboarding, Snowmobiling) 16,948
Horseback Riding 14,466
Gymnastics/Dance/Cheerleading 10,223
Golf 10,035
Hockey 8,145
Other Ball Sports and Balls, unspecified 6,883
Trampolines 5,919
Rugby/Lacrosse 5,794Roller and Inline Skating 3,320
Ice Skating 4,608
Sport Estimated Number of Head InjuriesCycling 40,272
Football 21,878
Baseball and Softball 18,246
Basketball 14,952Skateboards/Scooters 14,783
Water Sports 12,843
Soccer 8,392
Powered Recreational Vehicles 6,818
Winter Sports 6,750
Trampolines 5,025
Table 1
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Injury is the leading cause of morbidity and mortality for youths aged 10-19 years. (Laraque, Barlow, & Durkin, 1999,
p.551). Establishing preventive measures is going to play a key role in reducing the number of sport related head injuri
In order to establish these measures there needs to be an increase in knowledge of concussion rates, patterns and risk
factors (Gessel, et al., 2007). Continual analysis of the available data will also help reduce the number of sport related
head injuries (Mueller, 2001). Injury prevention activities should utilize both data and sound theoretical frameworks to
reduce the injury mortality and morbidity in youth (Laraque, et al., 1999).
Additionally, after a robust discussion, testimony from sport-related concussion experts, literature extracted from peer-
reviewed journals, and the careful narrowing of the studys scope, The Study Council agreed upon four core research
questions to pursue:
RQ1: How prevalent were Emergency Department visits for sport-related and non-sports related Traumatic BrainInjuries (TBI) in children between the ages of 10-18 in a seven county region in Northeast Florida between 2006
2009?
RQ2: How prevalent were Hospital Admissions for sport-related and non-sports related Traumatic Brain Injuries(TBI) in children between the ages of 10-18 in a seven county region in Northeast Florida between 2006-2009?
RQ3: What were the demographic characteristics of children between the ages of 10-18 with sport-related andnon-sports related Traumatic Brain Injuries (TBI) in a seven county region in Northeast Florida between 2006-
2009?
RQ4: What was the utilization pattern for neuro-imaging (i.e. CT scans) for children between the ages of 10-18presenting in Emergency Departments in Northeast Florida between the years 2006-2009?
The Health Planning Council requested and received an IRB study exemption from the University of Floridas Institutiona
Review Board. An IRB number was assigned by the University of Floridas Executive Committee and is available for revie
upon request. Based on the four core research questions, members of the Study Council identified and collected severa
secondary qualified healthcare utilization data from Floridas Agency for Health Care Administration (AHCA). This is
aggregate utilization data; no personal identifying information or patient level data was retrieved or included in the data
The Center for Healthy Equity and Quality Research at the University of Florida, College of Medicine Jacksonville (CHEQ
developed an analysis plan to ensure a complete and valid data analysis process. Throughout this report, you will see t
terms concussion, head injury, and traumatic brain injury (TBI) used interchangeably. This is due, in large part, by
inconsistent definition and use of the word concussion between the local, state and national medical communities,
levels of government, sport-related organizations, and researchers. For this report, the study council attempted to use th
term traumatic brain injury or TBI where ever appropriate, while trying to maintain the validity of the national and sta
reported data.
The following information outlines the analysis plan and the secondary data requested from AHCA:
Population: Children 10 18
2006-2009 trends
959.01 - Head Injury without LOC
854 through 854.19 - Intracranial Injury of Other and Unspecified Nature
850 through 850.9 - Concussion
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2. Sports related was defined as including one or more of the following ECodes:
E849.4 - Occurrence Sports/Recreational Related Injury Codes
E886.0 - In sports
o
Tackles in sportsE917.0 - In sports without subsequent fallo Kicked or stepped on during game (football) (rugby)o Struck by hit or thrown ballo Struck by hockey stick or puck
E917.5 - Object in sports with subsequent fall
o Knocked down while boxing
3. CPT Scans was defined as including any of the following Procedure Codes for CT scan:70450 - CT Head/Brain w/o Contrast
70460 - CT Brain with Contrast
70470 - CT Brain w/o Without Contrast
Outpatient- Emergency Department (ED) visits:
Data was analyzed for Emergency Department visits for a seven county region includingBaker, Clay, Duval, Flagler,Nassau, St. Johns, & Volusia counties. Patients who visited the ED and received an ICD9 code in any of the first 9diagnoses for Traumatic Brain Injury (TBI) were first compared against all ED visits, and then classified into sports and no
ports related TBI. Analysis examined demographic characteristics of patients with TBI sports and non-sports related inju
Demographic characteristics included the patients age, gender, race, method of ED payment, county of residence, and t
day of the week they come to the ED. Information was also analyzed by hospital and by procedure code to examine CT
utilization rates.
npatient Hospital Admissions:
Data was analyzed for Hospital Admissions for a seven county region includingBaker, Clay, Duval, Flagler, Nassau, St
ohns, & Volusia counties. Patients who were admitted to the hospital and received an ICD9 code in any of their diagnategories (primary the 9th diagnosis) for Traumatic Brain Injury (TBI) were first compared against all hospital admissio
and then by sports and non-sports related TBI. Analysis was then completed to examine demographic characteristics of
patients with TBI sports and non-sports related injuries. Demographic characteristics included the patients age, gender
ace, method of hospital payment, county of residence, and the day of the week they came to the hospital. Information w
also analyzed by hospital and by hospitalization characteristics including length of stay (LOS), gross charges, and source
admission and discharge status.
Additional data for the seven-county region of Northeast Florida was gathered from the Florida Community Health
Assessment Resource Tool Set (CHARTS) and the Florida Department of Health. Data on the state level was collected fro
CHARTS and the Well Florida Council. National data was collected from the Centers for Disease Control (CDC), the Journa
Head Trauma Rehabilitation, and the Well Florida Council.
FindingsThe following section reports comprehensive data collected from all sources, progressing from a national scope, to a
tatewide scope, and finally data concerning the seven counties of Northeast Florida: Baker, Clay, Duval, Flagler, Nassau
ohns, and Volusia.
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National DataNumbers and age-adjusted rates per 100,000 population for traumatic brain injury
deaths, by year, sex, and race/ethnicity 1997--2007
Year SexWhite, non-
HispanicBlack, non-
Hispanic
American
Indian/Alaska
Native
Hispanic Other/Unknown
Total
No. Rate No. Rate No. Rate No. Rate No. No. Rate
1997
M 28,165 30 5,571 37.2 465 50.7 3,468 24.8 854 38,523 30.5
F 10,887 9.9 1,707 10 153 15.4 836 6.3 357 13,940 9.6
Total 39,052 19.3 7,278 22.4 618 32 4,304 15.3 1,211 52,463 19.3
1998
M 28,293 30 5,334 35.7 423 41.6 3,444 23.9 842 38,336 30.1
F 11,143 10 1,598 9.2 179 16.6 887 6.7 363 14,170 9.6
Total 39,436 19.3 6,932 21.2 602 28.5 4,331 15.1 1,205 52,506 19.1
1999
M 27,884 29.4 5,166 34.4 441 43.4 3,445 23.8 829 37,765 29.3
F 11,145 9.8 1,638 9.4 165 15.7 870 6.3 358 14,176 9.4Total 39,029 18.9 6,804 20.7 606 29 4,315 14.7 1,187 51,941 18.7
2000
M 27,357 28.6 4,947 31.7 421 40 3,656 23.2 808 37,189 28.3
F 10,528 9.4 1,502 8.4 170 14.7 939 6.6 352 13,491 8.9
Total 37,885 18.3 6,449 19 591 26.6 4,595 14.8 1,160 50,680 18
2001
M 28,634 29.6 5,028 32 437 40.3 3,921 23.3 855 38,875 29.2
F 10,883 9.5 1,457 8.2 190 16.7 989 6.7 366 13,885 9
Total 39,517 18.9 6,485 19 627 28 4,910 14.9 1,221 52,760 18.5
2002
M 28,519 29.2 4,909 30.9 485 42.8 3,968 23 890 38,771 28.7
F 10,897 9.5 1,467 8 174 14.9 989 6.2 386 13,913 9
Total 39,416 18.7 6,376 18.4 659 28.4 4,957 14.4 1,276 52,684 18.2
2003
M 28,394 28.9 5,030 31 503 45.3 4,023 22.4 825 38,775 28.4
F 10,937 9.4 1,539 8.4 166 14.7 1,068 6.7 398 14,108 8.9
Total 39,331 18.5 6,569 18.8 669 29.4 5,091 14.5 1,223 52,883 18.1
2004
M 28,502 28.7 4,934 30.6 439 38.5 3,996 21.3 755 38,626 27.9
F 11,391 9.7 1,510 8.2 166 13.4 1,040 6.3 417 14,524 9.1
Total 39,893 18.6 6,444 18.3 605 25.3 5,036 13.8 1,172 53,150 18
2005
M 29,497 29.4 5,229 31.5 478 39.6 4,324 22.7 884 40,412 28.8
F 11,340 9.5 1,514 8.2 160 13.2 1,091 6.2 389 14,494 8.9
Total 40,837 18.9 6,743 18.9 638 26 5,415 14.4 1,273 54,906 18.3
2006M 29,119 28.7 5,296 31.2 460 38.5 4,322 21.7 832 40,029 28.1F 11,385 9.4 1,446 7.6 154 12.3 1,057 5.9 394 14,436 8.8
Total 40,504 18.6 6,742 18.4 614 24.9 5,379 13.7 1,226 54,465 17.9
2007
M 29,593 28.9 5,069 29 429 36.3 4,197 20.8 884 40,172 27.9
F 11,462 9.3 1,441 7.5 145 11.7 1,086 5.8 410 14,544 8.7
Total 41,055 18.6 6,510 17.5 574 23.6 5,283 13.3 1,294 54,716 17.8
Source: Centers for Disease Control and Prevention, Surveillance for Traumatic Brain Injury-Related Deaths
Table 3
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Age-Adjusted Rate of Traumatic Brain Injury Deaths (All Ages) By Race 1997-2007
Source: Centers for Disease Control and Prevention, Surveillance for Traumatic Brain Injury-Related Deaths
Age-Adjusted Rate of Traumatic Brain Injury Deaths (All Ages) By Gender 1997-2007
Source: Centers for Disease Control and Prevention, Surveillance for Traumatic Brain Injury-Related Deaths
Figure 1
Figure 2
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Table 4
Age-Adjusted Rate of Traumatic Brain Injury Deaths By Age 1997-2007
Source: Centers for Disease Control and Prevention, Surveillance for Traumatic Brain Injury-Related DeathsState Data
The number and rate of Traumatic Brain Injury-Related Deaths by Age Group, Florida 1997-2007
From 1997-2007, the rate of traumatic brain injury-related deaths has decreased across all displayed age ranges
Age 0-4: -1.3; Age 5-9: -1.3; Age 10-14: -2.3; Age 15-19: -9.4.
Age Group0--4 5--9 10--14 15--19
Year Number Rate Number Rate Number Rate Number Rate1997 1,147 6.0 640 3.2 1,027 5.2 4,996 25.81998 1,154 6.0 664 3.2 1,060 5.3 4,802 24.21999 1,045 5.5 633 3.1 881 4.4 4,627 23.02000 1,077 5.6 624 3.0 829 4.0 4,539 22.42001 1,059 5.5 568 2.8 797 3.8 4,265 20.92002 986 5.0 503 2.5 785 3.7 4,345 21.22003 1,065 5.3 455 2.3 818 3.9 4,062 19.72004 1,016 5.0 447 2.3 761 3.6 4,002 19.22005 1,054 5.1 440 2.2 685 3.3 3,964 18.82006 1,002 4.9 438 2.2 637 3.1 3,877 18.12007 978 4.7 382 1.9 593 2.9 3,547 16.4
Source: Centers for Disease Control and Prevention, Surveillance for Traumatic Brain Injury-Related Deaths
Figure 3
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Non-Fatal Head Injury Hospitalization for Ages 12-18, Florida Department of Health, 1999-2009
Source: Florida Department of Health, Bureau of Vital Statistics (CHARTS)
Data Source: Florida Agency for Health Care Administration (AHCA).
The rate per 100,000 for non-fatal head injury hospitalizations of patients ages 12-18 decreased from the
1999-2001 rate of 79.2 to the 2007-2009 rate of 67.4, an 11.8 per 100,000 decrease.
Figure 4
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Figure 5
Emergency Department Visits, TBI vs. Non-TBI,
Florida Agency for Health Care Administration, 2006-2009
There is a noticeable increase in the number of emergency department visits in 2009. Additionally, 2009 saw
the largest percentage of emergency department visits resulting from TBI, at 2.15%. In 2006: 1.97%; 2007: 2.09
2008: 1.85%.
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI)
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14ED and Hospital Admission Rates for Youth Sport Related Concussions
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Emergency Department Visits, TBI, Sports vs. Non-Sports,
Florida Agency for Health Care Administration, 2006-2009
From 2006 to 2009, Sports related Traumatic Brain Injuries (TBI) accounted for 15% of all TBIs reported during this
timeframe. There was an increase in the number of children 10 18 years of age who went to the ED for treatment
of a sport-related TBI between 2006 and 2009 from 154 to 269 people, a 75% increase but the overall number of
TBI for this period also increased.
Figure 6
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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Table 5
Emergency Department Visits, TBI, Sports vs. Non-Sports, By Age
Florida Agency for Health Care Administration, 2006-2009
The number of emergency department visits from 2006-2009 for patients with TBI increases steadily with age.
However, the percentage of those visits that are sports-related do not follow this pattern.
Age Percentage of TBI visits that are sports-related
10 13.8%
11 14.8%12 14.8%
13 16.5%
14 20.1%
15 18.9%
16 17.8%
17 13.3%
18 5.0%
Figure 7
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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Emergency Department Visits, TBI, Sports vs. Non-Sports, By Gender
Florida Agency for Health Care Administration, 2006-2009
Males make many more emergency department visits for TBI. Additionally, the percentage of visits that are
sports-related for males (17.8%) is higher than for females (8.8%). This disagrees with Covassin et al. Their
rate was higher in females.
Figure 8
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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17ED and Hospital Admission Rates for Youth Sport Related Concussions
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Emergency Department Visits, TBI, Sports vs. Non-Sports, By Race
Florida Agency for Health Care Administration, 2006-2009
While White resident emergency department visits with TBI are double Black and Other put together, they
have the lowest *value of sports-related TBI visits (14.3%). Black: 15.2% Other: 16.4%.
*This data was not statistically tested to see if chance could account for this variation.
Figure 9
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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18ED and Hospital Admission Rates for Youth Sport Related Concussions
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Emergency Department Visits, TBI, Sports vs. Non-Sports, By Payor
Florida Agency for Health Care Administration, 2006-2009
53% of all emergency department visits for patients with TBI was paid for with private insurance. The highest
proportion of sports-related TBI occurred in those who pay via military benefits (23.7%).
Payor Percentage of Sports-Related TBI
Commercial 17.5%
Medicaid 11.2%
Self-Pay 7.6%
Military 23.7%
Other 13.1%
Figure 10
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Table 6
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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19ED and Hospital Admission Rates for Youth Sport Related Concussions
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Emergency Department Visits, TBI, Sports vs. Non-Sports, By County
Florida Agency for Health Care Administration, 2006-2009
Duval County has the highest number of visits for patients with TBI (2,410). However, St. Johns County has the
highest proportion of those visits stemming from sports-related TBI (24.7%).
County Percentage of TBI visits that are sports-related
Duval 12.7%
Volusia 15.0%
St. Johns 24.7%
Clay 14.9%
Flagler 19.9%
Nassau 11.6%
Baker 8.2%
Figure 11
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Table 7
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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20ED and Hospital Admission Rates for Youth Sport Related Concussions
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Emergency Department Visits, TBI, Sports vs. Non-Sports, By Day of the Week
Florida Agency for Health Care Administration, 2006-2009
There is limited variation in emergency department visits across day of the week (Min = 808, Max = 893). Friday
sees the largest percentage of sports-related visits with 17.4%.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Total Cases 869 807 840 839 893 872 808
Sports-related % 13.0% 14.4% 14.5% 15.4% 17.4% 15.3% 11.5%
Figure 12
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Table 8
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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21ED and Hospital Admission Rates for Youth Sport Related Concussions
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TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns, & Volusia Counties
Source: Florida Agency for Health Care Administration
Table 9
Emergency Department Visits, TBI, Sports vs. Non-Sports, By Hospital
Florida Agency for Health Care Administration, 2006-2009
TBI Sports-Related and Non Sports-Related Hospital Data Throughout Seven Florida CountiesHospital Name
TBI Sports-
Related
TBI Non Sports-
related
% of Sports-Related
TBI
Florida Hospital, Ormond Hospital 37 121 30.6%
Baptist Medical Center- Nassau 25 136 18.4%
Florida Hospital, Flagler 39 169 23.1%
Baptist Medical Center - Beaches 49 195 25.1%
Florida Hospital - Deland 42 243 17.3%
Baptist Medical Center South 94 287 32.8%
Flagler Hospital 28 299 9.3%
Florida Hospital Fish Memorial 47 322 14.6%
Halifax Health Medical Center 86 367 23.4%
Orange Park Medical Center 60 377 15.9%
Baptist Medical Center -Downtown 143 592 24.2%
Shands Jacksonville 87 958 9.1%
Other (Hospitals with counts
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22ED and Hospital Admission Rates for Youth Sport Related Concussions
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Figure 14
Emergency Department Percentage of Visits, CT Scan for TBI, Sports vs. Non-Sports,
Florida Agency for Health Care Administration, 2006-2009
Of note, the numbers of ordered CT scans for sports and non-sports related TBI have decreased over the study
period (2006-2009) by 17.6% and 11.3% respectively. This could be due to recently published guidelines
for CT scan imaging in pediatric TBI (Osmond, 2010; Kupperman, et al, 2009).
In addition, the decrease in the number of ordered CT scans could be due the general awareness by parents and
ED physicians of the increase risk of subsequent malignancy in pediatric patients undergoing CT since children are
10 times more radiosensitive than adults (Brody, Frush, Huda, et al; American Academy of Pediatrics, 2007).
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
CT utilization is defined based on procedure codes: 70450, 70460, & 70470
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Outpatient (Emergency Department Visits) forTraumatic Brain Injury (TBI) Sports and Non-Sports Related
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23ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI and Non-TBI,
Florida Agency for Health Care Administration, 2006-2009
There is a noticeable decrease in the number of hospital admission visits in 2009. Additionally, 2009 saw the
smallest percentage of hospital visits result from TBI, at 1.1% (In 2006: 1.4%; 2007: 1.5%; 2008: 1.2%).
Figure 15
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia CountiesSource: Florida Agency for Health Care Administration
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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24ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related TBI,
Florida Agency for Health Care Administration, 2006-2009
From 2006-2009, TBI hospital admissions dropped by 15 patients. The percentage of those patients who had
sports-related TBI increased slightly over the same timeframe (2006: 5.1; 2009: 5.5). Additionally, 2007 saw
the highest number of admissions (99) and the highest percentage of sports-related TBI admissions (10.1%)
from 2006-2009.
Figure 16
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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25ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, By Age,
Florida Agency for Health Care Administration, 2006-2009
Incidence of TBI increases overall with age. However, ages 12 and 14 have the highest proportion sports-related
TBI (15.8% and 15.4% respectively). The numbers are sport-related TBI are very small so these differences are
somewhat irrelevant.
Age Percentage of TBI visits that are sports-related
10 6.7%
11 9.1%12 15.8%
13 8.3%
14 15.4%
15 9.8%
16 4.6%
17 4.9%
18 1.2%
Figure 17
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Table 10
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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26ED and Hospital Admission Rates for Youth Sport Related Concussions
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TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Hospital Admissions for Patients with TBI Sports and Non-Sports Related, By Gender,
Florida Agency for Health Care Administration, 2006-2009
The percentage of hospitalizations of male patients presenting to the ED with TBI were as follow:Sport-related TBI: 2.5%
Non-sport related TBI: 6.85%
On the other hand, the percentage of hospitalizations of female patients presenting to the ED with TBI
were as follow:
Sport-related TBI: 4.25%
Non-sport related TBI: 16.5%
Therefore, the hospitalization of female patients presenting to the ED with TBI was higher than males particularly in
non-sport related TBI.
Gender ED visits for
sports-related
TBI
ED visits for non-
sports related TBI
Hospitalization
for sports-related
TBI
Hospitalization for
non- sports related
TBI
Male 673 3,107 17 213
Female 188 1,960 8 323
Figure 18
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
Table 11
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27ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, By Race,
Florida Agency for Health Care Administration, 2006-2009
White resident emergency department visits with TBI are double Black and Other put together. Black
patients have the lowest proportion of sports-related TBI visits (6.2%). Other patients have a very high
percentage (22.2%).
Figure 19
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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28ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, By Payor,
Florida Agency for Health Care Administration, 2006-2009
Commercial payment was used for the most patients (242). The payment option with the highest percentage
of sports-related TBI was military (25.0%).
Payor Percentage of Sports-Related TBI
Commercial 6.6%Medicaid 6.3%
Self-Pay 6.3%
Military 25.0%
Other 0.7%
Figure 20
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Table 12
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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29ED and Hospital Admission Rates for Youth Sport Related Concussions
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TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia Counties
Source: Florida Agency for Health Care Administration
Hospital Admissions for Patients with TBI Sports and Non-Sports Related, By County,
Florida Agency for Health Care Administration, 2006-2009
Duval County saw the highest number of hospital admissions for patients with TBI (111).
County Percentage of TBI visits that are sports-related
Duval 5.4%
Volusia 7.7%
St. Johns 0%
Clay 3.3%
Flagler 18.2%
Nassau 0%
Baker 8.3%
Figure 21
Table 13
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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30ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, By Day of the Week,
Florida Agency for Health Care Administration, 2006-2009
Saturday saw the highest number of admissions for TBI (66) from 2006-2009, but Friday had the highest
percentage of sports-related admissions (18.2%).
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Total Patients 58 43 39 44 44 66 54
Sports-related % 3.4% 9.3% 2.6% 6.8% 18.2% 6.1% 5.6%
Figure 22
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns,
& Volusia CountiesSource: Florida Agency for Health Care Administration
Table 14
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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31ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, By Hospital,
Florida Agency for Health Care Administration, 2006-2009
Hospital Name TBI Sports-Related TBI Non Sports-related % of Sports-Related TBI
Baptist Medical Center-Downtown 5 16 23.8
Halifax Health Medical Center 15 116 11.5
Shands Hospital Jacksonville 4 177 2.2
Shands has the highest volume of hospital admissions for patients with TBI (181) but Baptist Medical Center
Downtown serves the highest percentage of sports-related TBI patients (23.8%).
Rates for the other hospitals were too small to report.
Figure 23
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns, &
Volusia Counties
Source: Florida Agency for Health Care Administration
Table 15
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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32ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, Mean Length of Stay (LOS),
Florida Agency for Health Care Administration, 2006-2009
Across each year between 2006-2009, sports-related TBI resulted in shorter length of stay than non-sports
related TBI. Both types of TBI have decreased in length of stay from 2006 (sports-related: -0.2; non-sports
related: -0.3)
Figure 24
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns, &
Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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33ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, Mean Gross Charges,
Florida Agency for Health Care Administration, 2006-2009
Mean gross charges are consistently higher for non-sports related TBI, possibly because their length of stay is
consistently longer.
Figure 25
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns, &
Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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34ED and Hospital Admission Rates for Youth Sport Related Concussions
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Hospital Admissions for Patients with TBI Sports and Non-Sports Related, Discharge Status,
Florida Agency for Health Care Administration, 2006-2009
A substantial amount of patients with TBI were discharged Home (306) than Other (42). Additionally, only one
sports-related TBI patient was discharged to somewhere other than home.
Figure 26
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns, &
Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Inpatient Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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35ED and Hospital Admission Rates for Youth Sport Related Concussions
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Figure 27
Hospital Admissions for Patients with TBI Sports and Non-Sports Related, Admission Type,
Florida Agency for Health Care Administration, 2006-2009
Fewer TBI patients were admitted as Emergency than Other. However, a much larger proportion of those
admitted as Emergency were sports-related (Emergency: 12.3% Other: 2.7%).
TBI is defined as 850 through 850.9 or 900 through 900.9 or 959.01 or 854 through 854.19
Sports Related is defined as E849.4 or E886.0 or E917.0 or E917.5
Data is provided for a seven county region including Baker, Clay, Duval, Flagler, Nassau, St. Johns, &
Volusia Counties
Source: Florida Agency for Health Care Administration
Regional Inpatient (Hospital Admissions) for Traumatic BrainInjury (TBI) Sports and Non-Sports Related
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36ED and Hospital Admission Rates for Youth Sport Related Concussions
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Recommendations
Members of the study council and the Health Planning Council recommend the following actions steps:
1. Develop a Youth Sport-Related Concussion Task ForceIt is recommended that a neutral, but topically qualified entity build on the momentum of this report and convene
the medical community, sport-related organizations, public and private school associations, researchers, athletic
trainers, advocates, parents and policy-makers and develop a Youth Sport-Related Concussion Task Force to:
Agree on the consistent use of the terms concussion head injury, and traumatic brain Injury
Agree on a consistent, formalized, and ethical process for reporting incidence and prevalence of
traumatic brain injuries at all levels of sports and recreation, diagnosis, hospital discharge
procedures, treatment, follow up and return-to-play decisions
Develop a coordinated and comprehensive public awareness campaign to educate coaches,
hospital staff, parents, pediatricians, students and athletic trainers on the signs and symptoms of a
traumatic brain injury, treatment and follow up procedures
Identify funding (and leverage community assets) to execute study recommendations, measure results,
and invest in local bio-science research and development relating to sport related traumatic brain
injuries
2. Develop a Community-Based Research AgendaAlthough the small numbers of sport related traumatic brain injury (TBI) limit the generalizability and interpretation
of the data provided, the following areas of research should be explored and or conducted:.
Examine the apparent disparity between gender and self- identified racial/ethnic group differences.
This includes exploring the barriers to health care access for such injuries. Proposed barriers are
parental and athletes limited knowledge of the clinical presentation of TBI as well as lower income
preventing parents from seeking care in either the ED or outpatient follow up of TBI symptoms.
Further studies should focus on the impact of sport related TBI on the athletes neuro-cognitive and
behavior changes and its consequences on quality of life and school performance
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37ED and Hospital Admission Rates for Youth Sport Related Concussions
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References
American Association of Neurological Surgeons. (Updated 2010, July). Sports-Related Head Injury. Retrieved June 22,
2011 from http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Sports-
Related%20Head%20Injury.aspx.
Bailes, J.E., Hudson, V. (2001). Classification of sport-related head trauma: a spectrum of mild to severe injury. Journa
of Athletic Training, 36(3), 236-243.
Brody AS, Frush DP, Huda W, et al; American Academy of Pediatrics Section on Radiology. Radiation risk to children
from computed tomography. Pediatrics. 2007;120(3):677-82.
Centers for Disease Control and Prevention, Surveillance for Traumatic Brain Injury-Related Deaths. (2011, May 6).
Traumatic brain injury deaths. Retrieved June 22, 2011, from
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6005a1.htm?s_cid=ss6005a1_w
Centers for Disease Control and Prevention, Surveillance for Traumatic Brain Injury-Related Deaths. (2011, May 6).
Traumatic brain injury deaths by age group. Retrieved June 22, 2011, from
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6005a1.htm?s_cid=ss6005a1_w
Centers for Disease Control and Prevention, Traumatic Brain Injury in the United States. (2011, May 6). Average annua
data of traumatic brain injury-related emergency room visits. Retrieved June 22, 2011 from
http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf
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