Category: Brain Injury; Health Services Research; International
Objective : To identify sex-differences in the rate of comorbid neck injuries among all patients with a concussion-related emergency department (ED) visit, by cause of injury (motor vehicle collision and sports).
Design : Retrospective cohort study.
Setting : Ontario, Canada (39% of Canadian population).
Participants (or Animals, Specimens, Cadavers) : All patients with a concussion-related ED visit in Ontario, Canada between fiscal years 2002/03 and 2011/12, identified using International Classification of Diseases Version 10 codes in the National Ambulatory Care Reporting System, a population-based dataset that captures all ED and ambulatory care in Ontario.
Interventions : Not applicable.
Main Outcome Measure(s) : Age-dependent odds ratio of comorbid neck injury for sex, estimated using polynomial logistic regression models, adjusting for sociodemographic and clinical characteristics.
Results : There were 90,1754 concussion-related ED visits between fiscal years 2002/03 and 2011/12, of whom 53% were males. The rate of comorbid neck injuries per 100,000 concussion-related ED visits was higher among females (4,333 vs. 2,995 per 100,000). Females had significantly higher odds of sustaining a comorbid neck injury between the ages of five to 49 years for all concussion-related ED visits, 15 to 49 years for motor vehicle collision-related ED visits, and 10 to 39 years for sports-related ED visits, holding all other covariates in the model constant.
Conclusions : These results support the consideration of increased awareness of comorbid neck injuries, particularly for females, to allow for early intervention and appropriate care. Future studies on concussions should also consider both linear and non-linear sex and age interactions, as this study found an that the increased risk of comorbid neck injuries in females with a concussion-related ED visit was age-dependent, with the interaction between sex and age following a non-linear trend.
Mitchell Sutton– PhD Trainee, University of Toronto, Toronto, Ontario
Vincy Chan– Scientific Associate III, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
Tatyana Mollayeva– Post Doctoral Fellow, Toronto Rehab-UHN, Toronto, Ontario
Zheng Hu– PhD Trainee, University of Toronto, Toronto, Ontario
Michael Escobar– Professor, Dalla Lana School of Public Health, Toronto, Ontario
Angela Colantonio– Professor and Director, University of Toronto, Toronto, Ontario