Diagnosis and acute management of patients with concussion at children's hospitals

Abstract

ObjectivesTo describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients.DesignCross-sectional study.SettingChildren's hospitals participating in the Pediatric Health Information System in the USA during a 10-year period.PatientsAll emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion.Main outcome measuresThe proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion.ResultsThe number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US$695, IQR US$472–$1009, vs US$191, IQR US$114–$287). An ED visit with CT, however, cost less than a hospitalisation without CT (US$1907, IQR US$1292–$3770).ConclusionsAlthough the number of ED patients diagnosed with concussion has increased, the number admitted has remained stable. Concussion patients at paediatric hospitals in the USA commonly undergo CT imaging and receive medication.

Gender- and Sex-specific Sports-related Injury Research in Emergency Medicine: A Consensus on Future Research Direction and Focused Application

“…6 Between 2001 and 2010, the number of ED visits by children for the diagnosis and management of sports and other traumarelated concussion has doubled. 7 Reasons for this include increased awareness due to legislation mandating concussion recognition education of coaches, athletes, and their parents; public head injury prevention campaigns such as the CDC's Heads Up campaign (http://www.cdc.gov/concussion/headsup/youth.html); broad media attention given to professional athletes who have suffered and died as a result of head injuries; and focus on legal settlements involving professional organizations.…”

Utility of surveillance imaging after minor blunt head trauma

“…A heightened awareness of concussion signs and symptoms together with increased use of CT imaging has resulted in more ED visits 4 and, correspondingly, neurosurgeons' involvement. The neurosurgical literature contains abundant small case series and reports documenting complications that may develop subacutely after these seemingly innocuous injuries, including growing skull fractures, 5,6,9,10 cranial nerve injuries 3,8,12 and posttraumatic hydrocephalus.…”

“…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.…”

The Recommendation for Rest Following Acute Concussion

“…Recent studies suggest that concussions account for more than 10% of all sport-related injuries sustained by high school athletes and reveal an increase in the number children with concussions being cared for in emergency departments. [1][2][3] At present, the mainstay of concussion management calls for both cognitive and physical rest until the acute symptoms resolve, followed by a graded return to activity. 4 As noted by several medical societies, the evidence on which the recommendations for rest are based is sparse.…”