Variations in Mechanisms of Injury for Children with Concussion

Abstract

Objectives To assess the distribution of injury mechanisms and activities among children with concussions in a large pediatric healthcare system. Study design All patients, age 0–17 years, who had at least 1 clinical encounter with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of concussion in the Children’s Hospital of Philadelphia’s electronic health record system from July 1, 2012 to June 30, 2014, were selected (N = 8233) and their initial concussion-related visit identified. Approximately, 20% of the patients (n = 1625) were randomly selected for manual record review to examine injury mechanisms and activities. Results Overall, 70% of concussions were sports related; however, this proportion varied by age. Only 18% of concussions sustained by children aged 0–4 were sports related, compared with greater proportions for older children (67% for age 5–11, 77% for age 12–14, and 73% for age 15–17). When the concussion was not sports related, the primary mechanisms of injury were struck by an object (30%) and falls (30%). Conclusions Sports-related injuries in children older than 6 years of age contributed to the majority of concussions in this cohort; however, it is important to note that approximately one-third of concussions were from non–sports-related activities. Although there is increased participation in community and organized sports activities among children, a focus on prevention efforts in other activities where concussions occur is needed.

Initial Emergency Department Visit and Follow-Up Care for Concussions among Children with Medicaid

“…Parents have become more aware of the negative consequences of concussions, leading to a greater appreciation of the timeline for gradual return to play and/ or the need for follow-up with a primary care provider for assurance of safe return to normal activities. 4,26 Our study has several limitations. First, this study was unable to assess potential unmeasured factors, including trends in ED and related follow-up visits for all patients, that may contribute to our observed patterns of ED visits and follow-up care.…”

“…25 Future studies should further examine the mechanisms associated with the reduction. 26 Almost one-half of our study sample only had a single encounter following their concussion without any additional follow-up care. Although it is unclear why patients did not seek additional care, these patients may have initially visited the ED to confirm the concussion diagnosis.…”

“…Furthermore, the higher rates of initial ED encounters among males compared with females, and among the 10-to 14-year-old and 15-to 18year-old age groups when compared with the 0-to 4-yearold and 5-to 9-year-old age groups, are likely due to higher sports participation rates in these groups, which is consistent with previous study findings. 8,26 The observed shift in type of healthcare provider encountered, specifically the decrease in claims for care by ambulance and radiology providers, can be partly attributed to the increased treatment of mild injuries at ED and/or the reduced reliance on imaging, which is needed only if a more severe TBI is suspected. Previous studies have demonstrated the Sport Concussion Assessment Tool-3rd edition (SCAT3) and ChildSCAT3 for children ages 5-12 years had a high sensitivity in measuring the signs and symptoms of concussions in an ED setting, 27,28 reducing the need for diagnostic radiology.…”

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

“…26 Musculoskeletal cervical complaints may respond to multifaceted physical therapy. 105 Pediatric considerations There is expert consensus that management of school-aged children and adolescents with mTBI should consider that (1) recovery time might be slower than adults, 102,135 (2) child-validated symptom rating scales and assessment tools, such as the Child SCAT5 109 are most appropriate, (3) return to activity advice to prevent reinjury should include nonsport play, 136 especially in unpredictable environments (eg, schoolyard), and (4) successful return to school (ie, symptom-free during school activities with no accommodations) should precede return to sport. 22,26…”

Using Community Detection Analysis to Elucidate Caregivers’ Mental Models of Pediatric Concussion Symptoms

“…The current study fills this gap and provides a new approach that can assist researchers and clinicians towards developing education and prevention efforts. For example, counter to overall injury risks, females are more frequently diagnosed with concussions in both sports and non-sports contexts and report poorer post-concussion outcomes than males [42][43][44]. Many theories have been proposed to explain why girls have higher rates of diagnosed concussion injuries, including physiological ones like girls having greater ball-to-head ratios and weaker neck muscles [45].…”