: Concussion is a type of traumatic brain injury (TBI) that can be sustained through sport-related and non-sport-related (e.g., motor vehicle accidents, falls, assaults) mechanisms of injury (MOI). Variations in concussion incidence and MOI may be present throughout the four geographic regions (Midwest, Northeast, South, West) of the United States. However, there is limited evidence exploring concussion cause and diagnosis patterns based on geographic region and MOI. These factors have implications for better understanding the burden of concussion and necessary efforts that can translate to the mitigation of safety concerns. Purpose: The purpose of this study was to identify patterns of sport-related concussion (SRC) and non-sport-related concussion (NSRC) across the four geographic regions of the United States. Methods: A descriptive epidemiology study of patient visits to the emergency department (ED) for concussion between 2010 and 2018, using publicly available data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was conducted. The exposure of interest was geographic region while the main outcome measures were concussion diagnosis and MOI. Descriptive statistics were calculated using population-weighted frequencies and percentages. The association between geographic region and MOI (SRC vs. NSRC) was analyzed using logistic regression models. Odds ratios (OR) presented with 95% confidence intervals (CI) were included. Univariate analyses were conducted followed by multivariable analyses adjusting for sex, age, race/ethnicity, and primary source of payment. Statistical significance was set at < 0.05 for all analyses. Results: From 2010 to 2018, 1,161 visits resulted in a concussion diagnosis, representing an estimated 7,111,856 visits nationwide. A greater proportion of concussion diagnoses occurred within EDs in the South (38.2%) followed by the West (25.8%), Midwest (21.4%), and Northeast (14.6%). Compared to the West region, patients visiting the ED in the Midwest (OR = 0.75, 95% CI = 0.57–0.98) and Northeast (OR = 0.71, 95% CI = 0.51–0.98) had a lower odds of being diagnosed with a concussion. More patients sustained a NSRC MOI (94.3%) compared to SRC MOI (5.7%). For both mechanisms, the South region had the highest population-weighted frequency of SRC (n = 219,994) and NSRC diagnoses (n = 2,495,753). Univariate and multivariable logistic regression analyses did not reveal statistically significant associations for geographic region and MOI ( > 0.05). Conclusion: Our findings showed that the Midwest and Northeast regions had a lower odds of concussion diagnoses in EDs. Overall, the vast majority of concussions were not sport-related, which has public health implications. These findings improve our understanding of how concussion injuries are being sustained geographically nationwide and help to explain care-seeking patterns for concussion in the ED setting.

中文翻译：

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美国急诊科就诊的运动和非运动相关脑震荡的地理特征

：脑震荡是一种创伤性脑损伤 (TBI)，可通过运动相关和非运动相关（例如机动车事故、跌倒、袭击）损伤机制 (MOI) 持续。美国四个地理区域（中西部、东北部、南部、西部）的脑震荡发生率和 MOI 可能存在差异。然而，基于地理区域和 MOI 探索脑震荡原因和诊断模式的证据有限。这些因素有助于更好地了解脑震荡的负担和必要的努力，从而减轻安全问题。目的：本研究的目的是确定美国四个地理区域的运动相关脑震荡 (SRC) 和非运动相关脑震荡 (NSRC) 的模式。方法：利用国家医院门诊医疗调查 (NHAMCS) 的公开数据，对 2010 年至 2018 年间因脑震荡而前往急诊科 (ED) 就诊的患者进行了描述性流行病学研究。感兴趣的暴露是地理区域，而主要结果指标是脑震荡诊断和 MOI。使用人口加权频率和百分比计算描述性统计数据。使用逻辑回归模型分析地理区域和 MOI（SRC 与 NSRC）之间的关联。包括以 95% 置信区间 (CI) 表示的比值比 (OR)。进行单变量分析后，进行多变量分析，调整性别、年龄、种族/民族和主要付款来源。所有分析的统计显着性均设为 < 0.05。结果：从 2010 年到 2018 年，有 1,161 次就诊被诊断为脑震荡，相当于全国估计有 7,111,856 次就诊。脑震荡诊断发生在南部急诊室的比例较高（38.2%），其次是西部（25.8%）、中西部（21.4%）和东北部（14.6%）。与西部地区相比，中西部地区（OR = 0.75，95% CI = 0.57–0.98）和东北部地区（OR = 0.71，95% CI = 0.51–0.98）就诊的患者被诊断患有以下疾病的几率较低：脑震荡。与 SRC MOI (5.7%) 相比，更多患者维持 NSRC MOI (94.3%)。对于这两种机制，南部地区 SRC (n = 219,994) 和 NSRC 诊断 (n = 2,495,753) 的人口加权频率最高。单变量和多变量逻辑回归分析并未揭示地理区域和 MOI 之间的统计显着关联 (> 0.05)。结论：我们的研究结果表明，中西部和东北地区急诊科诊断出脑震荡的几率较低。总体而言，绝大多数脑震荡与运动无关，这对公共健康有影响。这些发现提高了我们对全国范围内脑震荡损伤如何发生的理解，并有助于解释急诊室脑震荡的就医模式。