Evaluation of Emergency Medicine Discharge Instructions in Pediatric Head Injury

Sarsfield, Matthew; Morley, Eric J.; Callahan, James M.; Grant, William D.; Wojcik, Susan

doi:10.1097/pec.0b013e31829ec0d9

Cited by 26 publications

(18 citation statements)

References 16 publications

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“…Barriers to reporting concussive symptoms such as the desire to 'want to keep playing' have been identified in the literature [36] . Additionally, children who have sustained head injuries have been found to be inadequately instructed to restrict athletic activities upon discharge from emergency departments [37] . Health care providers have an integral role in identifying symptoms and addressing postconcussion symptom management.…”

Section: Discussionmentioning

confidence: 99%

Symptom Experience and Quality of Life in Children after Sport-Related Head Injuries: A Cross-Sectional Study

Vassilyadi

Macartney²,

Barrowman³

et al. 2015

Pediatr Neurosurg

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Background: Sports are a major cause of concussions, and little is known about the symptom experience and health-related quality of life (HRQL) in children who remain symptomatic for over 3 months following such head injuries. Methods: A cross-sectional study of children aged 10-18 years was performed who were referred to the Neurosurgery Clinic at our centre following a head injury. Symptom experience was measured using the modified Concussion Symptom Scale, and HRQL was measured using the Pediatric Quality of Life Inventory (PedsQL). The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to assess neurocognitive and neurobehavioural sequelae. Results: Symptoms with the highest mean symptom scores on a Likert scale of 0-6 in 35 children at the time of assessment included headaches (3.1), poor concentration (2.7), memory problems (2.1), fatigue (2.1) and sensitivity to noise (2.0). Compared with normative data, children in this study had ImPACT summary scores between the 28th and 38th percentiles and a comparably low Cognitive Efficiency Index score. Mean scores for females were consistently statistically significantly lower (p < 0.05) than for males across all of the HRQL domains. Trouble falling asleep and memory problems explained 62% of the variance in the PedsQL total scores. Conclusions: Children continue to experience many symptoms at least 3 months following sport-related head injuries that significantly impact their HRQL and neurocognitive abilities.

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Section: Discussionmentioning

confidence: 99%

Symptom Experience and Quality of Life in Children after Sport-Related Head Injuries: A Cross-Sectional Study

Vassilyadi

Macartney²,

Barrowman³

et al. 2015

Pediatr Neurosurg

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“…In 5 studies, 50À54 investigators used epidemiologic data, chart reviews, or cross-sectional surveys to identify the recommendations given to those with concussion and adherence to guidelines. Emergency department or trauma center chart reviews 51,54 indicated that children were discharged without adequate concussion-specific activity restrictions (eg, restriction from athletic participation, avoidance of activities that require attention to visual or auditory stimuli). When patients were surveyed, a lack of appropriate return-to-play advice was evident.…”

Section: Compliance With Return To Activitymentioning

confidence: 99%

Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

McLeod

Lewis

Whelihan

et al. 2017

Journal of Athletic Training

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Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers.

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“…Methods of diagnosis, 4,11 hospital admission criteria, 1,15 identification of child abuse victims, 2,17 and return-to-play criteria 13,14 are just some of the active areas of research. Follow-up care of pediatric patients with minor head trauma, accompanied by surveillance imaging when appropriate, is rendered by primary physicians, neurosurgeons, and sports medicine programs among others.…”

confidence: 99%

Utility of surveillance imaging after minor blunt head trauma

Chern

Sarda

Howard

et al. 2014

PED

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Object Nonoperative blunt head trauma is a common reason for admission in a pediatric hospital. Adverse events, such as growing skull fracture, are rare, and the incidence of such morbidity is not known. As a result, optimal follow-up care is not clear. Methods Patients admitted after minor blunt head trauma between May 1, 2009, and April 30, 2013, were identified at a single institution. Demographic, socioeconomic, and clinical characteristics were retrieved from administrative and outpatient databases. Clinical events within the 180-day period following discharge were reviewed and analyzed. These events included emergency department (ED) visits, need for surgical procedures, clinic visits, and surveillance imaging utilization. Associations among these clinical events and potential contributing factors were analyzed using appropriate statistical methods. Results There were 937 admissions for minor blunt head trauma in the 4-year period. Patients who required surgical interventions during the index admission were excluded. The average age of the admitted patients was 5.53 years, and the average length of stay was 1.7 days; 15.7% of patients were admitted for concussion symptoms with negative imaging findings, and 26.4% of patients suffered a skull fracture without intracranial injury. Patients presented with subdural, subarachnoid, or intraventricular hemorrhage in 11.6%, 9.19%, and 0.53% of cases, respectively. After discharge, 672 patients returned for at least 1 follow-up clinic visit (71.7%), and surveillance imaging was obtained at the time of the visit in 343 instances. The number of adverse events was small and consisted of 34 ED visits and 3 surgeries. Some of the ED visits could have been prevented with better discharge instructions, but none of the surgery was preventable. Furthermore, the pattern of postinjury surveillance imaging utilization correlated with physician identity but not with injury severity. Because the number of adverse events was small, surveillance imaging could not be shown to positively influence outcomes. Conclusions Adverse events after nonoperative mild traumatic injury are rare. The routine use of postinjury surveillance imaging remains controversial, but these data suggest that such imaging does not effectively identify those who require operative intervention.

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Evaluation of Emergency Medicine Discharge Instructions in Pediatric Head Injury

Abstract: Children sustaining head injury were inadequately instructed to restrict athletic activities upon discharge. This is particularly true for patients who sustain an mTBI from non-sports-related activity.

Cited by 26 publications

References 16 publications

Symptom Experience and Quality of Life in Children after Sport-Related Head Injuries: A Cross-Sectional Study

Symptom Experience and Quality of Life in Children after Sport-Related Head Injuries: A Cross-Sectional Study

Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

Utility of surveillance imaging after minor blunt head trauma

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