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Acute sports concussion Return to play issues in sports concussion
Variability in discharge instructions and activity restrictions for patients evaluated in a children's emergency department following concussion
  1. Valerie J De Maio1,2,*,
  2. Damilola O Joseph2,
  3. Holly Tibbo-Valeriote1,
  4. Brian Lanier1,
  5. Johna Register-Mihalik1
  1. 1Emergency Services Institute, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
  2. 2Wake Emergency Physicians, Pennsylvania, USA


    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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