Outpatient follow-up and return to school after emergency department evaluation among children with persistent post-concussion symptoms

Abstract

Objective To describe differences in outpatient follow-up and academic accommodations received by children with and without persistent post-concussion symptoms (PPCS) after emergency department (ED) evaluation. We hypothesised that children with PPCS would have more outpatient visits and receive academic accommodations more often than children without PPCS and that follow-up would be positively associated with receiving accommodations. Methods Children aged 8–18 years with acute (≤6 hours) concussion at time of presentation to a paediatric ED were enrolled in an observational study. Outcomes were assessed though telephone survey 30 days after injury. Results Of 234 enrolled participants, 179 (76%) completed follow-up. PPCS occurred in 21%. Only 45% of subjects had follow-up visits after ED discharge. Follow-up visit rates were similar for those with and without PPCS (58% vs. 41% respectively; p=0.07). Children with PPCS missed twice as many school days as those without (3 vs 1.5; p<0.001) but did not differ in receiving academic accommodations (36% vs 53%; p=0.082). Outpatient follow-up was associated with receiving academic accommodations (RR 2.2; 95% CI 1.4–3.5). Conclusions Outpatient follow-up is not routine for concussed children. Despite missing more school days, children with PPCS do not receive academic accommodations more often. Outpatient follow-up may facilitate academic accommodations.

The role of sleep deficiency in the trajectory of postconcussive symptoms in adolescents

“…As expected, there was a gradual and steady reduction of PCS over the first 3 weeks across both cognitive and somatic functioning. In line with findings from prior research (7,40), we found that 20% reported PCS at 3 weeks after concussion, and 12% of adolescents continued to experience PCS at 3 months after injury. We also examined trajectories of sleep deficiency (i.e., increased daytime sleepiness, reduced sleep duration, increased insomnia symptoms) finding variability over time.…”

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

“…Additionally, 44.7% of patients had worsening symptoms when they prematurely progressed through a return-to-learn protocol. Similarly, Grubenhoff et al 22 observed that adolescents with persistent postconcussive symptoms (ie, .1 month) missed 50% more school days than adolescents without such symptoms. However, the percentage of patients who received academic adjustments did not differ between those with and those without postconcussive symptoms, suggesting underuse of academic adjustments for patients who would likely benefit.…”

Initial somatic symptoms are associated with prolonged symptom duration following concussion in adolescents

“…The ability to identify factors associated with longer symptom duration soon after injury can help to guide clinicians making decisions about initiating therapy, assist with anticipatory guidance, and help patients prepare for difficulties at work and school caused by their symptoms . Factors such as loss of consciousness at the time of injury , amnesia at the time of injury , post‐traumatic migraine , anthropometric characteristics or previous concussion history have been identified as risk factors for developing persistent postconcussion symptoms in prior studies.…”