Follow-up visits after a concussion in the pediatric population: An integrative review

Abstract

BACKGROUND: Concussions are a significant health issue for children and youth. After a concussion diagnosis, follow-up visits with a health care provider are important for reassessment, continued management, and further education. OBJECTIVE: This review aimed to synthesize and analyse the current state of the literature on follow-up visits of children with a concussive injury and examine the factors associated with follow-up visits. METHODS: An integrative review was conducted based on Whittemore and Knafl’s framework. Databases searched included PubMed, MEDLINE, CINAHL, PsycINFO, and Google Scholar. RESULTS: Twenty-four articles were reviewed. We identified follow-up visit rates, timing to a first follow-up visit, and factors associated with follow-up visits as common themes. Follow-up visit rates ranged widely, from 13.2 to 99.5%, but time to the first follow-up visit was only reported in eight studies. Three types of factors were associated with attending a follow-up visit: injury-related factors, individual factors, and health service factors. CONCLUSION: Concussed children and youth have varying rates of follow-up care after an initial concussion diagnosis, with little known about the timing of this visit. Diverse factors are associated with the first follow-up visit. Further research on follow-up visits after a concussion in this population is warranted.

Analysis of a novel virtual pediatric concussion clinic in a rural setting

“…It is a feasible service demonstrated by a follow-up completion rate of 79.5% despite a wide range of residential locations (maximum of 958.3 miles from the hospital). This completion rate is on the higher end of follow-up visit rates compared to in-person concussion clinics discussed in a recent review by Ramsay et al, who reported a rate of follow-up visits across nine in-person clinics ranging from 13.2-99.5%, four clinics with completion rates > 50% and ve clinics < 50% [22]. This suggests a virtual model is not only reasonable but allows for a high rate of follow-up completion compared to urban locations.…”

“…Additionally, with a median follow-up time of 4.5 days, our clinic suggests that a virtual model excels in allowing providers to expedite the time it takes to provide follow-up care to patients who suffer a traumatic brain injury. In the same review, median follow-up times among eight in-person clinics were reportedly ranging from 4 days to 1.2 months [22], and interestingly, record of this important metric in concussion follow-up care is often not well represented in the literature, as only 8 of the 23 clinics cited in this review reported this data.…”

“…Reasons cited as barriers to completing follow-up visits by the authors of this review include socioeconomic variables, injury-related factors, and health service factors, however their overall ndings were variable, and more research is recommended to better identify those factors [22]. Our clinic's favorable follow-up rates and short time interval to follow-up completion suggest a virtual model could address those health care barriers, especially accessibility to health services in a rural setting and addressing patients' lack of knowledge of available resources [23].…”