Prevalence of parent-reported traumatic brain injury in children and associated health conditions.

Haarbauer-Krupa J, Lee AH, Bitsko RH, Zhang, X, and Kresnow-Sedacca K. JAMA Pediatrics. 2018. [Epub Ahead of Print].

Take Home Message: Children who are diagnosed with traumatic brain injuries (TBIs) are more likely to have a reported additional health concern (e.g., epilepsy/seizure disorder, intellectual disability, musculoskeletal problem, vision problem). TBIs are also more widely reported in states where estimates of private health insurance policies are higher.

Traumatic brain injuries (TBIs) are common among children and may be related to sport participation or other activities of daily living. Understanding how many children have a history of a TBI is the first step in the process of developing appropriate measures to safeguard children; however, no comprehensive data on TBI among children existed. Therefore, Haarbauer-Krupa and colleagues completed a study to estimate the national and state-specific prevalence of TBI based on a self-report by parents. Researchers analyzed data from the 2011-2012 National Survey of Children’s Health, a randomized telephone survey of US households. For the survey, parents answered questions related to 1 randomly selected child from 0 to 17 years of age. The survey asked about the family’s sociodemographic background, health insurance status, child’s history of TBI and other health conditions (ADHD, behavioral problems, etc.). Overall, the lifetime estimate of physician-diagnosed TBI during childhood as reported by a parent was 2.5% (2871/114,840). The prevalence of TBI increased with age (0-4, 5-11, 12-14, 15-17 years of age). Children with a history of TBI were also more likely have a parent report 13 of 14 other reported health conditions than children without TBI (especially, epilepsy/seizure disorder, intellectual disability, musculoskeletal problem, vision problem). Finally, states with higher estimates of private health insurance coverage were more likely to have higher reported TBI prevalence.

Overall, several different takeaway messages exist but we are largely left with more questions than questions answered. The data should be of interest to clinicians as it shows that children who suffered a TBI were more likely to have additional health conditions. However, clinicians should be cautious because it remains unclear if the other health conditions were present before the TBI or occurred because of the TBI. Therefore, the authors do not presume causation. The other interesting point to gather from this study is a correlation between being in a state with higher estimates of private health insurance and an increase in reported TBIs. While not definitive one could interpret this data as indicating that having better health insurance increases the likelihood that a TBI would be reported to a medical professional. Further, this could also be interpreted that not having adequate health insurance could result in an underreporting of TBI’s which could also be alarming. Athletic trainers may help ensure that at-least sports-related concussions are properly diagnosed, regardless of insurance. Furthermore, sports medicine professionals should be aware that TBIs may be related to other health conditions and these should be evaluated to ensure we treat the whole patient. For example, it may be helpful to offer medical advice to parents and athletes after considering the patients’ overall health history.

Questions for Discussion: Have you had experiences where any athletes with TBIs also have demonstrated any of the previously stated health concerns? Have you, as a health care professional felt that your athletes underreport TBI’s? If so, why do you think this is occurring?

Written by: Kyle Harris

Reviewed by: Jeffrey Driban

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