Concussions are all too common among athletes, whether they’re professionals or recreational players. Children, however, are often quite active regardless of whether they’re playing a sport, and can be at risk for concussions just from horsing around with their friends. A new report from The Children’s Hospital of Philadelphia (CHOP) and the Centers for Disease Control and Prevention (CDC) suggests the United States is currently underestimating the number and burden of pediatric concussions — kids may be bumping their heads a lot more than we previously thought.

Researchers used CHOP electronic health records to analyze more than 8,000 concussion diagnoses over the last four years. Among patients up to 17 years old, 82 percent had their first diagnosis at a primary care location and 5 percent at specialty care sites such as sports medicine and trauma centers. Only 12 percent got a diagnosis at the emergency room, yet many current estimations of pediatric concussions are based only on that data, the authors say, which means we are vastly underestimating child and youth concussion injury in the U.S.

“We learned two really important things about pediatric concussion and health care practices,” said Dr. Kristy Arbogast, lead author of the research and a codirector of CHOP’s Center for Injury Research and Prevention, in a statement. “First, four in five of this diverse group of children were diagnosed at a primary care practice — not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems that focus on high school athletes.”

Over the course of the study, primary care visits as a first point of contact for concussions increased 13 percent, while emergency room visits decreased by 16 percent.

“This study provides direction for health care networks and clinicians about the critical importance of providing targeted training and resources in primary care settings,” explained Dr. Christina Master, a coauthor of the study and pediatric sports medicine specialist at CHOP. “With targeted training and support, pediatric primary care providers are well-positioned to diagnose and treat the vast majority of concussions.”

Effective concussion treatment relies on early diagnosis, so primary care physicians have the advantage. Oftentimes, they can see injured patients sooner than specialized doctors, giving them a chance to diagnose a concussion and begin treatment sooner. Most concussions can be handled with physical and cognitive rest, followed by a gradual and supervised return to normal activity. If a patient’s symptoms linger for more than two to three weeks, it may be time to see a specialist.

“We need surveillance that better captures concussions that occur in children and adolescents,” said Dr. Debra Houry, Director of CDC’s National Center for Injury Prevention and Control. Houry said that better estimates of how often concussions occur, along with how they occur, will help the CDC prevent and treat them more effectively.

Source: Arbogast K, et al. Point of Health Care Entry for Youth With Concussion Within a Large Pediatric Care Network. JAMA Pediatrics. 2016.