• Keith Owen Yeates, Karen M Barlow, Bruce Wright, Ken Tang, Olesya Barrett, Edward Berdusco, Amanda M Black, Brenda Clark, Alf Conradi, Heather Godfrey, Ashley T Kolstad, Anh Ly, Angelo Mikrogianakis, Ross Purser, Kathryn Schneider, Antonia S Stang, Roger Zemek, Jennifer D Zwicker, and David W Johnson.
• Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N1N4, Canada. kyeates@ucalgary.ca.
• CJEM. 2023 Jul 1; 25 (7): 627636627-636.

ObjectivesTo test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs.MethodsStepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care.ResultsA total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites.ConclusionsImplementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient.Trial RegistrationClinicalTrials.gov NCT05095012.© 2023. The Author(s).

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