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

5.  ~ 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. N Data from Minnesota State TBI Registry Issue: Hospitalized patients only

7. Data from the Minnesota Hospital Association Issue: Identification of sport and recreation N

8.  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. N

10. 55% N Age group

11.  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.  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.  Concerns  Technical Development  Pilot program  Issues Encountered

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

15.  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?

20.  Schools with Fairview AT  Recruited school contact  Initial Paper reporting  Transitioned to Electronic

21.  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!!!!!

22.  Concussions by gender  Concussions by sports and gender  Concussions by type of event  Athletes missing school

23. Percent Sports Included: Basketball, Football, Hockey, Soccer, Volleyball, Wrestling

24. *Rates are per 100 participants Rate*

25. *Rates are per 100 events

26. N Missed School

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

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

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

30. Can we take it statewide?

31.  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?

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