Concussion in Fraser Health December 2015.Pdf

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CONCUSSION AMONG CHILDREN & YOUTH: FRASER HEALTH AUTHORITY The British Columbia Injury Research and Prevention Unit (BCIRPU) was established by the Ministry of Health and the Minister’s Injury Prevention Advisory Committee in August 1997. BCIRPU is housed in the Evidence to Innovation theme within the Child and Family Research Institute (CFRI) and supported by the Provincial Health Services Authority (PHSA) and the University of British Columbia (UBC). BCIRPU’s vision is “to be a leader in the production and transfer of injury prevention knowledge and the integration of evidence-based injury prevention practices into the daily lives of those at risk, those who care for them, and those with a mandate for public health and safety in British Columbia”. Acknowledgements: The BC Injury Research and Prevention Unit (BCIRPU) would like to acknowledge the contributions of Child Health BC in the development of this report. In particular, BCIRPU would like to acknowledge Jennifer Scarr, Provincial Lead, Health Promotion, Prevention and Primary Care, Child Health BC, who assisted in obtaining the National Ambulatory Care Reporting System data and provided the maps. Child Health BC is a network of BC health authorities, BC government ministries, health professionals, and provincial partners dedicated to improve the health status and health outcomes of BC’s children and youth by working collaboratively to build an integrated and accessible system of health services. One of the focus areas of Child Health BC is injury prevention.

Authors: Rachel Ramsden, Marina Wada, Fahra Rajabali, Kate Turcotte, Shelina Babul

Reproduction, in its original form, is permitted for background use for private study, education instruction and research, provided appropriate credit is given to the BC Injury Research and Prevention Unit. Citation in editorial copy, for newsprint, radio and television is permitted. The material may not be reproduced for commercial use or profit, promotion, resale, or publication in whole or in part without written permission from the BC Injury Research and Prevention Unit.

For any questions regarding this report, contact:

BC Injury Research and Prevention Unit F508-4480 Oak Street Vancouver, BC V6H 3V4 Email: [email protected] Phone: (604) 875-3776 Fax: (604) 875-3569 Web page: www.injuryresearch.bc.ca

Suggested Citation: Ramsden R, Wada M, Rajabali F, Turcotte K, Babul S. Concussion in Children and Youth: Fraser Health Authority. Vancouver, BC: BC Injury Research and Prevention Unit; 2015.

KEY HIGHLIGHTS The purpose of this report is to provide details on the  Male children and youth in Fraser Health had burden of concussion hospitalizations among children twice the rates of concussion hospitalizations as and youth in Fraser Health Authority. This report is females (19.3/100,000 vs. 9.4/100,000). targeted to health care providers and community  The leading causes of child and youth concussion stakeholders in the health authority to be used to hospitalizations in Fraser Health were due to falls facilitate discussion of the need for standardized (43%) and transport-related events (39%). concussion prevention, diagnosis and management  Among children and youth aged 0 to 19 years in specific to children and youth. Fraser Health, those under the age of five had the Evidence suggests that children and youth are at highest rates of fall-related concussion greater risk of concussion and more serious head hospitalizations (10.2/100,000) and older youth injury than the general population, take longer than aged 15 to 19 years had the highest rates for adults to recover following a concussion, and that transport-related concussions (10.3/100,000). concussions can permanently change the way a child  Older children in Fraser Health experienced a or youth talks, walks, learns, works and interacts with larger proportion of sport and recreation-related others. concussion hospitalizations as compared to younger children, with a greater rate of Concussion management and appropriate return to occurrence among males rather than females. activity is crucial, particularly in the paediatric and  Cycling (34.6%), hockey (11.9%) and playground adolescent populations. Active and timely rehabilita- (9.6%) activities were the greatest contributors for tion is essential for concussion patients who remain sport and recreation-related concussion symptomatic longer than a six week period. This may hospitalizations in Fraser Health among both include physiotherapy, occupational therapy, educa- males and females of all ages 0 to 19 years. tional support, neuropsychology and in some cases,  Child and youth residents within Fraser East had neuropsychiatry. the highest rates of concussion hospitalizations It is important to note that an individual is 3-times (22.6/100,000), with 84.6 percent admitted to more likely to sustain a second concussion while Fraser Health hospitals. recovering from the primary concussion. Further-  Leading causes of child and youth fall-related more, while a rare occurrence, a condition known as concussion hospitalizations in Fraser Health were second-impact syndrome (SIS) may occur if a second ‘fall on the same level’ (16.2%) and ‘fall involving injury to the brain is sustained within a day or two skates, skis and skateboards’ (13.1%). after the first concussive event. This leads to swelling  The local health areas of Mission (36.7/100,000) of the brain that can result in brain damage, causing and Hope (27.0/100,000) exhibited much higher severe disability and in a few cases even death. rates of concussion hospitalizations than the other Concussions are the most common form of head local health areas within Fraser Health. injury, yet this significant health issue is under-  Rates of emergency department visits were reported due to a lack of education and awareness highest among males and among children aged 0 among the general public and inconsistent and to 4 years of age within Fraser Health. limited availability of data around the burden of this  Surrey Memorial Hospital reported the highest injury. The data presented in this report represent number of concussion emergency department only a fraction of the children and youth that may visits (711 visits) in 2013/14 within Fraser Health. have sustained a concussion, as this report does not Concussions remain a significant health issue for capture concussions treated at physicians’ offices, children and youth in Fraser Health, and require walk-in clinics, or those not recognized and treated further attention given the potential for long-lasting at all. effects. This may include concussion prevention, Highlights include but are not limited to the following: education and awareness, standardizing care, ensuring correct treatment protocols are adhered to  From 2001/02-2013/14 there were 722 concussion and appropriate concussion management is hospitalizations among children and youth ages 0 employed. to 19 years who reside within Fraser Health.

TABLE OF CONTENTS

KEY HIGHLIGHTS ...... ii INTRODUCTION ...... 1 Purpose ...... 1 METHODOLOGY ...... 1 Data Sources ...... 2 Analysis ...... 2 Data Limitations ...... 3 CONCUSSION HOSPITALIZATION...... 2 Fall-related Concussion Hospitalization ...... 6 Transport-related Concussion Hospitalization ...... 9 Sport and Recreation-related Concussion Hospitalization ...... 11 Concussion Hospitalization between Health Service Delivery Areas ...... 13 Concussion Hospitalization by Health Service Delivery Area: Fraser South ...... 16 Concussion Hospitalization by Health Service Delivery Area: Fraser East ...... 19 Concussion Hospitalization by Health Service Delivery Area: Fraser North ...... 22 CONCUSSION EMERGENCY DEPARTMENT VISIT RATES ...... 25 CONCLUSION ...... 29 REFERENCES ...... 32

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INTRODUCTION Children and youth are at greater risk of concus- Active and timely rehabilitation is essential for sion and more serious head injury than the concussion patients who remain symptomatic general population. Concussions are the most longer than a six week period. This may include common form of head injury, yet it is believed physiotherapy, occupational therapy, educational that they are under-reported owing to both a lack support, neuropsychology and in some cases of consensus in the definition of a concussion and neuropsychiatry. It is important to note that an the presence of misconceptions among the individual is 3-times more likely to sustain a general public on the symptoms of concussion second concussion while in recovery from a [1]. The rate of concussion hospitalization in the concussion [7]. Also, while rare, a condition adult at-risk population has been measured at 1 known as second-impact syndrome (SIS) may to 3 per 1,000 in the United States, but it is occur if a second injury to the brain is sustained estimated that the true concussion rate could be within a day or two of the first concussion event, as high as 6 per 1,000 [2]. Nonetheless, where swelling of the brain that can result in concussions reportedly account for 3 to 8 percent brain damage causing severe disability or even of all sports-related injuries among youth death [8]. presenting to urban emergency departments in Purpose Canada, which is expected to increase as public The purpose of this report is to provide details awareness rises [1, 3]. Furthermore, studies using on the burden of unintentional concussion national injury reporting databases in the United hospitalizations and emergency department States indicate that sports-related injuries are visits among children and youth living within or responsible for 46 to 58 percent of all attending any of the hospitals in Fraser Health concussions suffered by youth between the ages Authority. This report will be used to facilitate of 8 and 19 years [1, 4]. Comparable Canadian discussion of the need for standardized data are not available. concussion prevention, diagnosis and Concussion, also known as mild traumatic brain management specific to children and youth. injury (mTBI), occurs as a result of an impact to or Concussion as a health event is recognized to be forceful motion of the head or other part of the under-reported and inconsistently coded. body, resulting in a jarring of the brain. This may Concussion may also be labelled as a minor lead to a brief alteration of mental status, which traumatic brain injury (mTBI), or sometimes as a may include: confusion, loss of memory directly ‘head injury’, which may include other injuries preceding the event, sensitivity to light, slurred not involving the brain. speech, dizziness, emotional changes, and may or may not be accompanied by loss of consciousness or seizures [1, 5, 6]. Evidence exists that children and youth take longer than adults to recover following a concussion [1], and that concussion can permanently change the way a child or youth talks, walks, learns, works and interacts with others. Therefore, concussion management and appropriate return to activity protocol are crucial, particularly in the paediatric and adolescent populations.

METHODOLOGY Data Sources for BC Children’s hospital was available from April Hospitalization Data: Discharge Abstract Data- 1, 2012 to May 21, 2015. base (DAD) obtained from the BC Ministry of Health was used to provide information on Analysis concussion hospitalizations for the fiscal years Hospitalization rates were calculated per 2001/02 to 2013/14. The data includes external 100,000 population for age, sex, year and causes of injury classified according to leading cause of injury. Age-specific and crude International Classification of Disease (ICD)-10 rates are used in the report to describe actual CA. In 2001, injury hospitalization data coding burden rather than comparative rates across switched from ICD-9 to ICD-10 CA. By 2002, all time and regions (where age-standardized rates hospitals in BC reported using ICD-10 CA for their would normally be used). The age-specific rates Discharge Abstract Data. Differences in numbers were calculated by dividing the number of cases between 2001 and 2002 may be attributed to in each age group by the population of that some hospitals still converting to the new coding specific age group within Fraser Health. Rates structure. Unintentional concussion presented by region are based on the patients’ hospitalizations were also extracted separately residence and not the location of injury using ICD-10 CA code S06. The hospitalization occurrence. data include all acute, rehab and day surgery Emergency department rates for Fraser Health cases. The data are based on hospital separations residents were calculated per 100,000 population rather than on patient, therefore multiple for the region and rates for each hospital were admissions of the same patient for the same calculated per 100,000 emergency department injury would be counted as separate cases. visits for all diagnoses. Emergency Department Visit Data: Emergency Population data were obtained from BC Vital department visit data are reported in two Statistics Agency. segments. The first is using all emergency department visits from hospitals within Fraser Trend analyses were conducted using a linear Health, and the second is emergency department regression model to test the statistical signi- visits to the BC Children’s Hospital by residents of ficance of the association between injuries over Fraser Health. Data were obtained from Decision time. This test appraises the linear component Support Services, Provincial Health Services of the relationship between injury rates and Authority (PHSA). The emergency department scores allocated to the categories of time (cal- data are part of the National Ambulatory Care endar years). In addition, Z tests for proportions Reporting System (NACRS). Data were available were conducted to test significance between for fiscal years 2013/14 to 2014/15 by age, sex age groups and region. and type of injury. Unintentional concussion Definitions for leading causes of concussion: emergency department visits were extracted  Transport-related events include: crashes separately using ICD-10 CA code S06. External involving cars, trucks, motorcycles, bicycles, codes for injury were not available and data by pedestrians, etc. cause of injury are therefore not presented for  Falls include: fall on the same level, fall from emergency department visits. Data for a height, falls on stairs or steps, fall from a emergency department visits to BC Children’s building or other structure, etc. Hospital by residents of Fraser Health were  Struck by/against an object includes: forceful extracted using postal code information that contact with a falling object, striking against represented the residence of the patient. Data or struck accidentally by objects or persons, 2

and caught between objects, depending on the coding system, struck by/against an object involving sport may be captured by sports and recreation activities. This category does not include assault.  Sports and recreational activities include: falls on same level from collision, pushing or shoving by or with other person in sports; striking against or struck accidentally by objects or persons in sports; and object in sports with subsequent fall.

Data Limitations Concussion as a health event is recognized to be under-reported and inconsistently coded. Concussion is often not clearly defined and may also be labelled as a minor traumatic brain injury (mTBI), or sometimes as a ‘head injury’ which may include other injuries not involving the brain. The data presented in this report represent only a fraction of the children and youth that may have sustained a concussion. This report does not capture concussions treated at physician offices, medical clinics, or not treated at all. Hospitalization data can vary over time and between areas for factors not related to health, such as accessibility of treatment, and medical or administrative decisions that may affect the number of hospitalizations and lengths of hospital stay [9, 10].

CONCUSSION HOSPITALIZATION There were 722 hospitalizations among children less than one year of age (5.9/100,000), and and youth aged 0 to 19 years resulting from highest among 10 to 14 year olds (17.0/100,000), concussion within Fraser Health over the 13-year followed by youth 15 to 19 years of age period from 2001/02 to 2013/14. Concussion (16.9/100,000) (Figure 1). hospitalization rates were lowest among infants

Figure 1: Concussion hospitalization counts and rates by age group, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

200 20.0

150 15.0

100 10.0

50 5.0

NumberofHospitalizations Rate per 100,000 Population

0 0.0 <1 1-4 5-9 10-14 15-19 Number of Hospitalizations 13 130 127 217 235 Rate per 100,000 Population 5.9 14.4 10.8 17.0 16.9

Age Group

Concussion hospitalization rates among children per 100,000 (Figure 2). Rates peaked for and youth were seen to vary from 2001/02 to females in 2001/02 at 13.8 per 100,000 and 2013/14 (Figure 2). Rates peaked in 2004/05 at were lowest in 2010/11 at 5.4 per 100,000. 18.5 per 100,000 and were lowest in 2008/09 at Males accounted for 69.0 percent (n=498) of all 10.2 per 100,000. Concussion hospitalization rates concussion hospitalizations among children and were consistently higher among males than youth. Rates for males were higher than for females from 2001/02 to 2013/14. females for all age groups, except among Concussion hospitalization rates peaked for infants less than one year of age (Figure 3). As males aged 0 to 19 years in 2004/05 at 27.8 per age increased, males accounted for higher rates 100,000, and were lowest in 2008/09 at 12.0 than females for all concussion hospitalizations.

Figure 2: Concussion hospitalization rates by year and sex, ages 0-19 years, Fraser Health, 2001/02 - 2013/14. 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Rate per 100,000 Population 2001/ 2002/ 2003/ 2004/ 2005/ 2006/ 2007/ 2008/ 2009/ 2010/ 2011/ 2012/ 2013/ 02 03 04 05 06 07 08 09 10 11 12 13 14 Male 20.7 21.7 23.8 27.8 21.6 15.3 19.7 12.0 13.4 15.7 21.5 22.0 16.1 Female 13.8 10.5 11.7 8.4 11.2 13.3 6.6 8.1 9.2 5.4 9.0 6.9 9.0 Total 17.4 16.3 18.0 18.5 16.6 14.4 13.4 10.2 11.4 10.8 15.5 14.8 12.5 Year

Figure 3: Concussion hospitalization rates by age group and sex, ages 0-19 years, Fraser Health, 2001/02 - 2013/14. 30.0 25.0 20.0 15.0 10.0 5.0 0.0

Rate per 100,000 Rateper 100,000 Population <1 1-4 5-9 10-14 15-19 Male 5.2 16.5 14.0 24.5 23.0 Female 6.6 12.2 7.4 8.9 10.1 Total 5.9 14.4 10.8 17.0 16.9 Age Group

Leading causes of concussion hospitalization Leading causes varied by age group, with falls among children and youth included falls, being the leading cause for 0 to 9 year olds, while transport-related events, and struck by/against transport-related events were the leading cause an object (Figure 4). Fall-related concussion of concussion hospitalizations for 10 to 19 year hospitalization was the leading cause for both olds (Figure 5). Concussion hospitalization rates males and females at 8.1 per 100,000 and 4.4 per for falls were highest among 1 to 4 year olds 100,000, respectively. Of those concussions (11.8/100,000), while transport-related caused by struck by/against an object, 73.4 concussion rates were highest among 15 to 19 percent occurred during sport and recreation year olds (10.3/100,000). The rate for transport- activities. related concussion among 15 to 19 year olds was significantly higher than the rates among children aged 10 to 14 years (p-value< 0.05). Figure 4: Concussion hospitalization rates by cause and sex, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

10.0 8.0 6.0 4.0 2.0 0.0 Falls Transport Struck by Object

Male 8.1 7.3 3.8 Rate per 100,000 Population Female 4.4 3.8 1.1 Total 6.3 5.6 2.5 Cause of Injury Note: * Represents fewer than 5 cases; Total also includes other causes of concussion hospitalizations which are not shown as there are no or fewer than 5 cases.

Figure 5: Concussion hospitalization rates by cause and age group, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

20.0 15.0 10.0 5.0 0.0 <1 1-4 5-9 10-14 15-19 Falls 5.4 11.8 6.0 6.4 3.1

Transport 0.0 1.3 3.1 6.9 10.3 Rate per 100,000 Population Struck by Object * 1.1 1.7 3.5 3.4 Total 5.9 14.4 10.8 17.0 16.9

Age Group

*Total includes all causes of concussion- Note: *Represents fewer than 5 cases; Total also includes other causes of concussion hospitalizations which are not shown as there are no or fewer than 5 cases. 6

Fall-related Concussion Hospitalization Concussion hospitalizations among children and among infants less than one year of age youth resulting from a fall were primarily the result (2.3/100,000). Among young children 1 to 4 years, of a fall on the same level (16.2%, n=51), falls falls from furniture and falls on the same level involving skates, skis and skateboards (13.1%, were the leading causes of fall-related concussion n=41), and falls from furniture and from high (2.2/100,000 and 1.6/100,000, respectively) (Figure levels, both at 9.6% (n=30) (Figure 6). Nearly one 7). Falls involving skates, skis and skateboards third of cases were classified as “other and resulting in a concussion were more common unspecified” falls (30.9%, n=97). Concussion- among older youth aged 10 to 14 years related falls from furniture was most common (1.5/100,000) and 15 to 19 years (1.3/100,000).

Figure 6: Proportion of fall-related concussion hospitalizations by type of fall, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

Fall on same level 16.2 Fall involving skates, skis, skateboards 13.1 Fall involving bed, chair and other furniture 9.6 Fall from high level 9.6 Fall on and from stairs/steps/ladder/scaffolding 8.6 Fall involving playground equipment

Typeof Fall 8.0 Fall involving wheelchair and other 2.5 Fall involving ice and snow 1.6 Other and unspecified falls 30.9

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 Percentage of Hospitalizations

Figure 7: Fall-related concussion hospitalization rates by type of fall and age group, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0

0.5 Rate per 100,000 Population 0.0 Fall on and Fall involving Fall involving Fall involving from Other and Fall on same bed, chair Fall from skates, skis, playground stairs/steps/ Unspecified level and other high level skateboards equipment ladder/ Falls furniture scaffolding <1 0.0 2.3 0.0 0.0 * * * 1-4 1.6 * 2.2 0.8 1.4 1.4 4.1 5-9 1.0 * * 0.9 0.4 0.7 2.6 10-14 1.3 1.5 * 0.5 * 0.5 2.1 15-19 0.4 1.3 0.0 0.0 * * 0.9 0-19 1.0 0.8 0.6 0.5 0.5 0.6 2.2 Type of Fall

Note: *Represents fewer than 5 cases; ‘Other and unspecified falls’ includes fall involving ice and snow and fall involving wheelchair.

Transport-related Concussion Hospitalization Concussion hospitalization rates from transport- Rates among males were highest for pedal cyclists related injuries among children and youth were (3.4/100,000) and motor vehicle occupants generally higher among males than females (Figure (1.9/100,000), while highest rates among females 8). were for motor vehicle occupants (1.8/100,000) followed by pedestrians (1.0/ 100,000).

Figure 8: Transport-related concussion hospitalization rates by type of transport and sex, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

3.4 Pedal cyclist 0.3

1.9 Motor vehicle occupant 1.8

1.1 Male Pedestrian 1.0 Female

Typeof Transport 0.5 Motorcyclist *

0.4 Other transport 0.3

0.0 1.0 2.0 3.0 4.0 Rate per 100,000 Population

Note: * Represents fewer than 5 cases; 'Other transport' includes concussion hospitalizations due to off-road vehicle, other land transport, and water transport.

Rates of motor vehicle occupant-related Across all age groups, highest rates were observed concussion hospitalization were highest among for either pedal cyclist or motor vehicle occupant youth 15 to 19 years (4.9/100,000) while pedal concussion hospitalizations compared to any other cyclist rates were highest among 10 to 14 year olds transport type. (3.8/100,000) (Figure 9).

Figure 9: Transport-related concussion hospitalization rates by type of transport and age group, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

6.0

5.0

4.0

3.0

2.0

1.0 Rate per 100,000 Population 0.0 Motor vehicle Other Motorcyclist Pedal cyclist Pedestrian occupant transport <1 0.0 0.0 0.0 0.0 * 1-4 0.6 0.0 * * 0.2 5-9 0.7 * 1.1 0.6 0.6 10-14 0.9 0.0 3.8 1.6 0.5 15-19 4.9 1.1 2.3 1.4 0.6 0-19 1.9 0.3 1.9 1.0 0.4 Type of Transport

Note: * Represents fewer than 5 cases; 'Other transport' includes concussion hospitalizations due to off-road vehicle, other land transport, and water transport.

Sport and Recreation-related Concussion Hospitalization Sport and recreation-related concussion hospitali- Cycling was the sport and recreation activity with zation rates for children and youth were generally the highest proportion of concussion hospitaliza- higher among males than females, with the highest tions among children and youth, at 34.6 percent rates being among males aged 10 to 14 years (n=90) (Figure 11). Other leading types included (15.4/100,000) and 15 to 19 years (10.5/ 100,000) hockey, playground, skis/snowboards and (Figure 10). Rates for females were highest for skateboards. children aged 10 to 14 years at 2.6 per 100,000.

Figure 10: Sport and recreation-related concussion hospitalization rates by age group and sex, ages 0-19 years, Fraser Health, 2001/02 – 2013/14. 20

Population 5 Rateper 100,000 0 <1 1-4 5-9 10-14 15-19 Male 0.0 1.5 4.6 15.4 10.5 Female 0.0 1.4 2.1 2.6 1.8 Total 0.0 1.4 3.4 9.2 6.4 Age Group

Figure 11: Sport and recreation-related concussion hospitalization rates by type of sport/recreation, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

Cycling 34.6 Hockey 11.9 Playground 9.6 Ski/Snowboard 6.5 Skateboard 5.0 Football/Rugby 5.0 All Terrain Vehicle 3.8 Hit by Ball 3.5 Ice Skates 1.9 Soccer 1.9 Scooter 1.5 Rollerblades 1.2 Baseball 1.2 Typeof Sport/ Recreation Tobogganing 0.8 Diving into Water 0.8 Hit by Bat 0.4 Other Sports 10.4 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Percentage

The rate of cycling-related concussion hospitali- Rates of cycling-related concussion hospitalizations zations for males was 2.4 per 100,000, followed by were highest among youth 10 to 14 years (3.8/ hockey (1.0/100,000) and playground (0.6/ 100,000) and 15 to 19 years (2.0/100,000) (Figure 100,000) (Figure 12). For females, highest rates 13). Playground concussion rates were higher were seen for cycling (0.3/100,000) and play- among younger children, while generally sport ground (0.3/ 100,000). concussion rates were highest among the older youth.

Figure 12: Sport and recreation-related concussion hospitalization rates by leading type of sport/recreation and sex, ages 0-19 years, Fraser Health, 2001/02 – 2013/14.

Male Female

Cycling 2.4 Cycling 0.3 Hockey 1.0 Playground 0.3 Playground 0.6 Hit by Ball 0.2 Ski/Snowboard 0.5 All Terrain Vehicle 0.1 Skateboard 0.4 Ski/Snowboard *

Football/Rugby 0.3 Football/Rugby * Typeof Sport/ Recreation All Terrain Vehicle 0.2 Hockey * 0.0 1.0 2.0 3.0 0.0 0.2 0.4 Rate per 100,000 Population Note: * Represents fewer than 5 cases

Figure 13: Sport and recreation-related concussion hospitalization rates by leading type of sport/recreation and age group, ages 0-19 years, Fraser Health, 2001/02 – 2013/14. 4.0

3.0

2.0

1.0

0.0 All Terrain Ski/ Football/ Rate per 100,000 Population Cycling Playground Hockey Hit by Ball Skateboard Vehicle Snowboard Rugby <1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1-4 * 0.8 * 0.0 0.0 0.0 0.0 0.0 5-9 1.1 0.9 * * * * 0.0 0.0 10-14 3.8 0.5 * 1.2 * 0.5 0.5 0.5 15-19 2.0 0.0 * 0.9 0.4 0.7 0.5 0.4 0-19 1.8 0.5 0.2 0.6 0.2 0.3 0.3 0.3

Type of Sport/ Recreation Note: * Represents fewer than 5 cases 12

Concussion Hospitalization between Health Service Delivery Areas Fraser Health consists of three Health Service Concussion hospitalization rates were highest Delivery Areas (HSDAs): Fraser East, Fraser among residents of Fraser East (22.6/100,000) North and Fraser South. The majority of Fraser and lowest among residents of Fraser South Health child and youth residents who were (12.3/100,000) (Figure 14). The highest number hospitalized for concussion sought treatment of concussion hospitalization cases was within within the Fraser Health Authority (Table 1). Fraser South (283 cases). Statistical testing About 85 percent of Fraser East residents were yields significant differences between Fraser admitted in hospitals within Fraser Health for East and Fraser South, and between Fraser East concussion; a higher proportion than for and Fraser North (p-value <0.05). residents of both Fraser North and Fraser South Concussion hospitalization rates within Fraser (71.9% and 76.7%, respectively). Provincial East were highest among all age groups except Health Services Authority (PHSA) was the next for infants less than one year of age (Figure 15). leading Health Authority providing hospital care The rates in Fraser East were also the highest for Fraser Health residents with concussion. when compared to the other HSDAs. Fraser South had the highest rate of concussion hospitalizations for infants less than one year of age (8.0/100,000).

Table 1: Concussion hospitalization counts by health service delivery area of patient’s residence and health authority in which treatment sought, ages 0-19 years, Fraser Health, 2001/02-2013/14.

Health Service Delivery Area of patient’s residence

Health Authority Fraser East Fraser North Fraser South in which treatment sought # # # Fraser Health 187 (84.6%) 164 (71.9%) 217 (76.7%) Interior Health * 9 11 Vancouver Coastal Health * 11 8 Island Health 0 * 6 Northern Health 0 0 * Provincial Health Service Authority + 17 (7.7%) 37 (16.2%) 39 (13.8%) Out-of-Province * * * Grand Total 221 228 283

Note: * Represents fewer than 5 cases; +Provincial Health Services Authority refers to BC Children’s Hospital.

Figure 14: Concussion hospitalization counts and rates by health service delivery area, ages 0-19 years, Fraser Health, 2001/02-2013/14. 300 25.0

250 20.0

200 15.0 150 10.0 100

5.0 Rate per 100,000 Population

50 NumberofHospitalizations

0 0.0 Fraser Fraser Fraser East North South Number of Hospitalizations 211 228 283 Rate per 100,000 Population 22.6 13.1 12.3 Health Service Delivery Area

Figure 15: Concussion hospitalization rates by health service delivery area and age group, ages 0-19 years, Fraser Health, 2001/02-2013/14. 35.0 30.0 25.0 20.0 15.0 10.0

5.0 Rate per 100,000 Population 0.0 <1 1-4 5-9 10-14 15-19 Fraser East * 23.2 18.3 29.1 23.3 Fraser North * 11.3 11.0 15.9 14.8 Fraser South 8.0 13.2 7.6 13.0 16.0 Total 5.9 14.4 10.8 17.0 16.9

Age Group

Note: * Represents fewer than 5 cases

The number of child and youth concussion The number of concussion inpatients was inpatients was highest in the Fraser South highest at Abbotsford Regional Hospital (20 residence, followed by the Fraser North cases) and Royal Columbian Hospital (16 cases) residence in 2013/14 (Figure 16). The munici- in the 2013/14 year (Figure 16). pality of White Rock and all areas of Fraser East, excluding the municipality of Abbotsford, report the lowest number of concussion inpatients from their regions.

Figure 16: Pediatric concussion Inpatients by local health area and hospital in the Fraser Health Authority, 2013/14.

Note: * Represents fewer than 5 cases Note: 32: Hope, 33: Chilliwack, 34: Abbotsford, 35: Langley, 37: Delta, 40: New Westminster, 41: Burnaby, 42: Maple Ridge, 43: Coquitlam, 75: Mission, 76: Agassiz-Harrison, 201: Surrey, 202: Surrey/White Rock

Concussion Hospitalization by Health Service Delivery Area: Fraser South

A total of 283 concussion hospitalizations were Concussion hospitalization rates were higher reported for Fraser South between 2001/02 and among males than females within all LHAs. The 2013/14. Among all age groups, 15 to 19 year highest rate among males was found in Langley olds had the highest rate of concussion, most of (22.0/100,000) and the lowest rates in Surrey which comprised of transport-related cases. (12.9/100,000). The highest rate among females was found in Langley (13.1/100,000) and the Rates of fall-related child and youth concussion lowest rate in Surrey (6.5/100,000) (Figure 19). hospitalization in Fraser South were highest among children and infants under the age of Within South Surrey/White Rock, the highest five years (Figure 17). rate of concussion hospitalization among children was among those aged 1 to 4 years Fraser South is split into four Local Health Areas (18.2/ 100,000), while Delta, Surrey and Langley (LHAs): Surrey, Delta, Langley and South had the highest rates for ages 10 to 19 years. Surrey/White Rock. Rates of child and youth Langley had the highest concussion concussion hospitalization were highest in hospitalization rates for 15 to 19 year olds Langley (17.7/100,000) and lowest in Surrey (27.4/100,000) (Figure 20). (9.9/100,000) (Figure 18).

Figure 17: Concussion hospitalization rates by cause and age group, ages 0-19 years, Fraser Health: Fraser South, 2001/02-2013/14. 20.0

15.0

10.0

5.0 Rate per 100,000 Population 0.0 <1 1-4 5-9 10-14 15-19 Falls 8.0 10.8 3.8 4.9 2.5 Transport 0.0 * 2.5 6.1 9.8 Struck by Object 0.0 1.2 1.3 1.9 3.5 Total 8.0 13.2 7.6 13.0 16.0 Age Group

Note: * Represents fewer than 5 cases; Total also includes other causes of concussion hospitalizations which are not shown as there are no or fewer than 5 cases.

Figure 18: Concussion hospitalization count and rate by local health area, ages 0-19 years, Fraser Health: Fraser South, 2001/02-2013/14.

140 20.0 120 100 15.0 80 10.0 60

40 5.0

20 NumberofHospitalizations 0 0.0 Rate per 100,000 Population South Surrey Delta Langley Surrey/ Whiterock Number of Hospitalizations 130 53 75 25 Rate per 100,000 Population 9.9 15.7 17.7 11.6 Local Health Area

Figure 19: Concussion hospitalization rates by local health area and sex, ages 0-19 years, Fraser Health: Fraser South, 2001/02-2013/14. 30.0

25.0

20.0

15.0

10.0

5.0 Rate per 100,000 Population 0.0 South Surrey/ Surrey Delta Langley Whiterock Male 12.9 21.3 22.0 16.3 Female 6.5 9.8 13.1 6.7 Total 9.9 15.7 17.7 11.6 Local Health Area

Figure 20: Concussion hospitalization rates by local health area and age group, ages 0-19 years, Fraser Health: Fraser South, 2001/02-2013/14.

30.0 25.0 20.0 15.0

Population 10.0 Rateper 100,000 5.0 0.0 South Surrey/ Surrey Delta Langley Whiterock <1 8.0 0.0 * 0.0 1-4 10.5 13.1 20.3 18.2 5-9 6.5 13.8 9.0 * 10-14 11.5 17.4 13.5 13.4 15-19 11.3 19.0 27.4 15.0 0-19 9.9 15.7 17.7 11.6

Local Health Area

Note: * Represents fewer than 5 cases

Concussion Hospitalization by Health Service Delivery Area: Fraser East

A total of 211 concussion hospitalizations were Concussion hospitalization rates were higher reported for Fraser East between 2001/02 and among males than females within all LHAs of 2013/14. Among all age groups, 10 to 14 year Fraser East. The highest rates among males and olds had the highest rate of concussion, most of females were both in Mission (38.0/100,000 which comprised of fall-related cases. and 35.3/ 100,000, respectively) (Figure 23). Rates of child and youth fall-related concussion Concussion hospitalization rates were hospitalizations in Fraser East were highest particularly high among 1 to 4 and 10 to 14 year among children aged 1 to 4 years olds in Mission (40.7/100,000 and 52.8/ (17.4/100,000), while transport-related 100,000, respectively). All LHAs within Fraser concussion hospitalization rates were highest East reported low rates of concussion among youth aged 15 to 19 years hospitalization among infants less than one year (13.4/100,000) (Figure 21). of age, where there were fewer than five cases reported to no cases (Figure 24). Fraser East is split into five LHAs: Mission, Abbotsford, Chilliwack, Agassiz-Harrison and Hope. The concussion hospitalization rate was highest in Mission (36.7/100,000) and lowest in Agassiz-Harrison (15.1/100,000). The total numbers of hospitalization cases within Fraser East were lowest in Agassiz-Harrison and Hope (Figure 22).

Figure 21: Concussion hospitalization rates by cause and age group, ages 0-19 years, Fraser Health: Fraser East, 2001/02-2013/14. 18.0 15.0 12.0 9.0 6.0 3.0 0.0

Rate per 100,000 Population <1 1-4 5-9 10-14 15-19 Falls 0.0 17.4 10.7 11.7 5.1 Transport 0.0 3.5 4.9 8.7 13.4 Struck by Object * * 2.7 8.7 4.7 Total * 23.2 18.3 29.1 23.3 Age Group

Note: * Represents fewer than 5 cases; Total also includes other causes of concussion hospitalizations which are not shown as there are no or fewer than 5 cases.

Figure 22: Concussion hospitalization counts and rates by local health area, ages 0-19 years, Fraser Health: Fraser East, 2001/02-2013/14. 120 40.0

100 30.0 80

60 20.0

40 10.0

NumberofHospitalizations 20 Rate per 100,000 Population * 0 0.0 Agassiz- Mission Abbotsford Chilliwack Hope Harrison Number of Hospitalizations 52 101 48 * 6 Rate per 100,000 Population 36.7 21.9 17.1 15.1 27.0

Local Health Area

Note: * Represents fewer than 5 cases

Figure 23: Concussion hospitalization rates by local health area and sex, ages 0-19 years, Fraser Health: Fraser East, 2001/02-2013/14. 40.0 35.0 30.0 25.0 20.0 15.0 10.0

5.0 Rate per 100,000 Population 0.0 Agassiz- Mission Abbotsford Chilliwack Hope Harrison Male 38.0 31.5 22.0 * * Female 35.3 11.4 7.2 * * Total 36.7 21.9 17.1 * 27.0 Local Health Area

Note: * Represents fewer than 5 cases

Figure 24: Concussion hospitalization rates by local health area and age group, ages 0-19 years, Fraser Health: Fraser East, 2001/02-2013/14.

50.0

40.0

30.0

20.0

10.0

0.0 Agassiz- Rate per 100,000 Population Mission Abbotsford Chilliwack Hope Harrison <1 0.0 0.0 * 0.0 0.0 1-4 40.7 25.1 13.5 * 0.0 5-9 26.8 19.0 14.7 0.0 * 10-14 52.8 27.7 17.6 * * 15-19 32.7 20.7 22.6 * * 0-19 36.7 21.9 17.1 * 27.0 Local Health Area

Note: * Represents fewer than 5 cases

Concussion Hospitalization by Health Service Delivery Area: Fraser North

A total of 228 concussion hospitalizations were Concussion hospitalization rates were higher reported for Fraser North between 2001/02 and among males than females for all LHAs of Fraser 2013/14. Among all age groups, 10 to 14 year North. The highest rates among males and olds had the highest rate of concussion, most of females were found in Maple Ridge (32.1/ which comprised of transport-related cases. 100,000 and 10.6/100,000, respectively) (Figure 27). Child and youth fall-related concussion hospitalization rates in Fraser North were Concussion hospitalization rates were lowest in highest among children aged 1 to 4 years Fraser North, across all LHAs, among infants less (10.0/100,000) (Figure 25). than one year of age, where there were fewer than five cases reported to no cases. Maple Fraser North is split into four LHAs: Maple Ridge had the highest rates of concussion Ridge, Coquitlam, New Westminster and hospitalizations among children and youth of all Burnaby. Concussion hospitalization rates were age groups (Figure 28). highest in Maple Ridge (21.7/100,000) and lowest in New Westminster (9.4/100,000) (Figure 26).

Figure 25: Concussion hospitalization rates by cause and age group, ages 0-19 years, Fraser Health: Fraser North, 2001/02-2013/14.

12.0 10.0 8.0 6.0 4.0 2.0 0.0

Rate per 100,000 Rateper 100,000 Population <1 1-4 5-9 10-14 15-19 Falls * 10.0 6.5 5.7 2.8 Transport 0.0 * 2.8 7.0 9.3 Struck by Object 0.0 * 1.8 2.9 2.8 Total * 11.3 11.0 15.9 14.8 Age Group

Note: * Represents fewer than 5 cases; Total also includes other causes of concussion hospitalizations which are not shown as there are no or fewer than 5 cases.

Figure 26: Concussion hospitalization counts and rates by local health area, ages 0-19 years, Fraser Health: Fraser North, 2001/02-2013/14. 100 25.0

80 20.0

60 15.0

40 10.0

20 5.0

0 0.0 NumberofHospitalizations New Rate per 100,000 Population Maple Ridge Coquitlam Burnaby Westminster Number of Hospitalizations 68 87 14 59 Rate per 100,000 Population 21.7 12.4 9.4 10.3 Local Health Area

Figure 27: Concussion hospitalization rates by local health area and sex, ages 0-19 years, Fraser Health: Fraser North, 2001/02-2013/14.

35.0 30.0 25.0 20.0 15.0 10.0

5.0 Rate per 100,000 Population 0.0 New Maple Ridge Coquitlam Burnaby Westminster Male 32.1 17.2 13.1 13.1 Female 10.6 7.2 * 7.2 Total 21.7 12.4 9.4 10.3

Local Health Area

Note: * Represents fewer than 5 cases

Figure 28: Concussion hospitalization rates by local health area and age group, ages 0-19 years, Fraser Health: Fraser North, 2001/02-2013/14. 40

Rate per 100,000 Population 0 Maple Ridge Coquitlam New Westminster Burnaby <1 * * 0.0 0.0 1-4 22.2 8.4 * 11.3 5-9 13.4 10.6 * 10.1 10-14 25.0 14.7 17.2 11.5 15-19 26.1 14.9 * 10.4 0-19 21.7 12.4 9.4 10.3

Local Health Area Note: * Represents fewer than 5 cases

CONCUSSION EMERGENCY DEPARTMENT VISIT RATES There were a total of 6,233 concussion Health. Lowest rates of concussion emergency emergency department visits by child and youth department visits were seen in Fraser North residents of Fraser Health between the years (767.1/100,000) (Figure 29). Concussion-related 2013/14 and 2014/15. Emergency department visits to the emergency department within rates for Fraser Health residents were calculated Fraser Health were highest among children per 100,000 population for the region. under the age of five years. Rates within Fraser East, Fraser North and Fraser South were Rates of emergency department visits for highest among infants less than one year concussion were highest in Fraser East (1,503.8/100,000, 1,596.5/ 100,000 and (834.2/100,000). Fraser East exhibited the 1,618.6/100,000, respectively) (Figure 30). highest rates among both males (979.9/ 100,000) and females (676.2/100,000) in Fraser

Figure 29: Concussion emergency department visit rates by health service delivery area and sex, ages 0-19 years, residents of Fraser Health, NACRS, 2013/14-2014/15

1200.0 1000.0 800.0 600.0 400.0 200.0 0.0 Fraser East Fraser South Fraser North Male 979.9 966.5 903.4 Rate per 100,000 Population Female 676.2 650.5 620.6 Total 834.2 814.3 767.1 Health Service Delivery Area

Figure 30: Concussion emergency department visit rates by health service delivery area residence and age group, ages 0-19 years, residents of Fraser Health, NACRS, 2013/14-2014/15

2,000.0

1,500.0

1,000.0

500.0

Rate per 100,000 Population 0.0 <1 1-4 5-9 10-14 15-19 Fraser East 1,503.8 1,261.5 568.1 750.3 729.3 Fraser North 1,596.5 1,084.7 621.1 667.4 624.0 Fraser South 1,618.6 1,241.4 644.7 748.9 607.2 Total 1,589.7 1,191.3 622.5 721.8 634.2 Age Group

Fraser Health Authority has 12 principal visits for both males and females hospitals with recorded concussion emergency (4,423.6/100,000 and 3,315.9/100,000, department visits: Abbotsford Regional, respectively). Males exhibited higher rates than Burnaby, Chilliwack General, Delta, Eagle Ridge, females among all Fraser Health hospitals. Fraser Canyon, Langley Memorial, Mission Lowest rates for both males and females were Memorial, Peace Arch, Ridge Meadows, Royal reported at Mission Memorial (1,376.9/100,000 Columbian and Surrey Memorial. Rates for each and 935.4/100,000, respectively) (Figure 31). hospital were calculated per 100,000 When looking at emergency department visits emergency department visits for all diagnoses. from concussions by month between April 1, There were a total of 5,634 child and youth 2013 and March 31, 2015, the number of cases concussion emergency department visits to presented were highest during the months of these hospitals between the years 2013/14 and February (570 visits), March (564 visits) and 2014/15 (Table 2). During this period, Langley November (530 visits). Rates of concussion Memorial reported the highest rate of emergency department visits per 100,000 concussion emergency department visits per emergency department visits peaked during 100,000 emergency department visits, among October and November (3,039.4/100,000 and all hospitals in the Fraser Health Authority at 3,051.4/ 100,000, respectively). The number of 3,905.8 per 100,000 visits (Figure 31). Lowest concussion emergency department visits were rates of emergency department visits due to lowest during July (357 visits) and August (368 concussion within the Fraser Health region were visits). Lowest rates were reported during seen at Mission Memorial (1,169.8/100,000). December and January (2,194.6/100,000 and Langley Memorial also reported the highest 2,329.2/100,000, respectively) (Figure 32). rates of concussion emergency department

Figure 31: Concussion emergency department visit rates by hospital and sex, ages 0-19 years, Fraser Health, NACRS, 2013/14-2014/15

5,000.0

4,000.0

3,000.0

2,000.0

Rate per 100,000 Visits 1,000.0

0.0 Abbotsford Chilliwack Fraser Langley Mission Ridge Royal Surrey Burnaby Delta Eagle Ridge Peace Arch Regional General Canyon Memorial Memorial Meadows Columbian Memorial Male 2,855.2 2,808.0 3,375.7 2,418.4 3,140.3 1,739.1 4,423.6 1,376.9 3,127.9 3,212.2 2,983.0 3,085.9 Female 1,930.1 1,932.6 2,410.4 1,610.3 2,540.2 1,542.6 3,315.9 935.4 2,286.3 2,408.6 2,373.7 2,352.6 Total 2,420.2 2,417.7 2,891.2 2,050.5 2,865.1 1,641.0 3,905.8 1,169.8 2,735.7 2,835.2 2,698.8 2,754.1

Hospital

Figure 32: Concussion emergency department visit rates and number of cases by month, ages 0-19 years, all Fraser Health Hospitals, NACRS, 2013/14-2014/15

800 3000.0 700 2500.0 600

500 2000.0

400 1500.0 300

1000.0 Numberofcases

200 Rate per 100,000 Visits 500.0 100

0 0.0 Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Number of cases 438 488 414 357 368 392 519 530 477 517 570 564 Rate per 2,869.12,941.72,677.72,463.12,558.22,609.33,039.43,051.42,194.62,329.22,789.32,646.4 100,000 Visits Month

The total numbers of child and youth During the 2013/14 year alone, emergency emergency department visits for concussion at department visits occurring at hospital locations Fraser Health treating hospital facilities were within Fraser Health were highest at Surrey highest for Surrey Memorial from 2013/14 to Memorial, which saw 711 concussion 2014/15 (1,687 cases) (Table 2). The highest emergency department visits. Emergency proportions of emergency department visits department visits were also high at Abbotsford attributed to child and youth concussion were Regional and Royal Columbian, each recording seen at Langley Memorial and Chilliwack 308 concussion visits. The lowest numbers of General (3.91% and 2.89%, respectively). Low child and youth emergency department visits numbers of visits were seen at Mission recorded in 2013/14 were seen at Mission Memorial (56 visits) and Fraser Canyon (49 Memorial (17 visits) and Fraser Canyon (21 visits). These two hospitals also reported the visits) (Figure 33). lowest proportion of concussion emergency department visits as a proportion of overall emergency department visits. Across all treating hospitals, Fraser Health saw an average 2.67 percent of all child and youth emergency departments visits attributed to concussion- related injury (Table 2).

Table 2: Concussion emergency department visit proportions by hospital, ages 0-19 years, Fraser Health, NACRS, 2013/14-2014/15 Number of ER Total ER % of concussion ER concussion visits visits visits Langley Memorial Hospital 383 9,806 3.91 Chilliwack General Hospital 466 16,118 2.89 Eagle Ridge Hospital 389 13,577 2.87 Ridge Meadows Hospital and Health Care Centre 291 10,264 2.84 Surrey Memorial Hospital 1,687 61,255 2.75 Peace Arch Hospital 334 12,209 2.74 Royal Columbian Hospital 629 23,307 2.70 Abbotsford Regional Hospital and Cancer Centre 680 28,097 2.42 Burnaby Hospital 505 20,888 2.42 Delta Hospital 165 8,047 2.05 Fraser Canyon Hospital 49 2,986 1.64 Mission Memorial Hospital 56 4,787 1.17 Grand Total 5,634 211,341 2.67

Figure 33: Pediatric concussion emergency department visits by local health area and hospital in the Fraser Health Authority, NACRS, 2013/14

Note: 21: Fraser East, 22: Fraser North, 23: Fraser South

EMERGENCY DEPARTMENT VISITS AT BC CHILDREN’S HOSPITAL

Among child and youth residents of Fraser (25.3/100,000 and 19.0/100,000, respectively). Health, rates of emergency department visits to Overall concussion emergency department visit BC Children’s Hospital were highest among rates at BC Children’s Hospital among children males and females less than one year of age for residing in Fraser Health were highest in infants concussion (Figure 34). Rates were lowest less than one year of age (231.2/100,000) and in among males and females 15 to 19 years of age children 1 to 4 years old (133.3/100,000).

Figure 34: Concussion emergency department visit rates at BC Children’s Hospital by age group and sex, ages 0-19 years, residents of Fraser Health, NACRS, April 1, 2012 – May 21, 2015

300.0

250.0

200.0

150.0

100.0

Rate per 100,000 Population 50.0

0.0 <1 1-4 5-9 10-14 15-19 Males 210.5 150.4 106.4 116.3 25.3 Females 253.3 114.8 50.9 48.9 19.0 Total 231.2 133.3 79.7 83.9 22.3

Age Group

CONCLUSION The Fraser Health region exhibited low overall had higher hospitalization rates of fall-related rates of child and youth concussion concussion among infants. hospitalization. The highest rates of concussion There was a large discrepancy in rates among hospitalizations were seen among the 15 to 19 LHAs. Mission, Maple Ridge and Hope exhibited year old age group, largely due to transport- much higher rates of concussion related causes. The majority of these hospitalizations than most regions in Fraser hospitalizations were due to the involvement of Health, while Surrey, South Surrey/White Rock pedal cyclists and motor vehicle occupants. and New Westminster reported low rates of Among children under the age of five years, falls child and youth concussion hospitalizations. remained the leading cause of concussion hospitalization. The leading cause of falls within Emergency department visits related to this age group was falls from furniture. concussion rates were higher among males than females residing within Fraser Health. Rates were Males within the Fraser Health exhibited higher also higher among children less than five years of rates of concussion hospitalizations than age. Overall, rates of concussion emergency females across all ages between 0 to 19 years. department visits among 0 to 19 year olds were Sport and recreation-related concussion highest among residents in Fraser East and Fraser hospitalizations were mostly observed among South. males between the ages of 10 and 19 years. Between April 1, 2013 and March 31, 2015, Transport-related concussion hospitalizations Langley Memorial Hospital had the highest rate of maintained similar patterns and trends across child and youth concussion emergency all HSDAs within Fraser Health, with rates department visits per 100,000 visits among all increasing as age increases. Out of all HSDAs, hospitals within the Fraser Health Authority, Fraser East displayed the highest rates of while Mission Memorial Hospital had the lowest transport-related concussion hospitalization rate. across most age groups. The months of October and November reported Fall-related concussion hospitalization rates the highest rates of concussion emergency varied with age within each HSDA. Children department visits per 100,000 visits, while the aged 1 to 4 years displayed the highest rates of months of February and March recorded the fall-related concussion hospitalization within all highest numbers of concussion emergency three HSDAs. Out of all HSDAs, Fraser East had department visits. the highest rate of fall-related concussion hospitalization for the 1 to 4 year old age This report provides a comprehensive glance at category. the burden of concussion among children and youth within Fraser Health, both at a regional and Few to no cases of fall-related concussion hospital level. With this information, Fraser hospitalization among infants less than one year Health can work towards reducing the occurrence of age were experienced by two of the three and burden of concussions among children and HSDAs compared to other HSDAs. Fraser South youth in BC.

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