Variability in discharge instructions and activity restrictions for patients evaluated in a children's emergency department following concussion

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Abstract

Objective

To describe discharge instructions given to school-aged patients evaluated in a children's emergency department (ED) following concussion.

Design

Retrospective cohort.

Setting

Dedicated children's ED (Level I Trauma Center).

Patients

All children 6–18 years evaluated in 2008 following head trauma regardless of mechanism, identified by any of 16 ICD-9 diagnostic codes for head injury, concussion, or skull fracture (n=350). Included (n=218): presentations consistent with 2008 Zurich consensus definition for concussion. Excluded (n=132): hospital admission, death, intoxication, structural neuroimaging abnormality.

Assessment of Risk Factors

Age, gender, mechanism, signs/symptoms.

Main Outcome Measurements

Univariate and multivariate analyses determined adjusted ORs for receipt of concussion-specific discharge instructions and activity restrictions.

Results

Patients were mostly male (68%) with mean age 12.8 years (sd=3.4). Injury characteristics included: sport-related 42%, fall 23%, loss of consciousness (LOC) 33%, headache 75%, dizziness 29%, amnesia 25%, vomiting 19%, imaging ordered 81%. Discharge characteristics included: concussion stated in final diagnosis 31%, concussion-specific instructions 62%, activity restrictions 34% (sport-related 42%, non-sport 29%). Concussion-specific instructions were more likely for LOC (OR 1.7, 95% CI 1.22 to 2.36) and activity restrictions more likely for amnesia (OR 1.42, 95% CI 1.01 to 1.98) and sport-related injury (OR 1.31, 95% CI 1.02 to 1.76).

Conclusions

Most children meeting diagnostic criteria for concussion were discharged without concussion-specific diagnoses or activity restrictions, even when the injury was sport-related. Given the risks associated with untimely return to both physical and cognitive activity after concussion, improved awareness and standardisation of discharge instructions is imperative for the management of these young patients in the ED.

Acknowledgements

We would like to confirm that none of the authors have any financial or commercial interest in this material.

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