Objective To evaluate characteristics of paediatric concussion patients utilising the emergency department (ED) prior to initial concussion clinic evaluation.
Design Prospective cohort.
Setting Clinics of an American urban/suburban family practice (12/2014–04/2015).
Subjects Consented concussion patients 8–18 years presenting to clinic within 3 days of injury (n=195; age=14.3, SD=2.1 years; female=42.3%).
Intervention Participants completed a systematic evaluation at initial clinic visit and survey at 4-6 weeks (73.8% follow-up). Criterion variables included demographics, prior head injury, time of injury (TOI) factors, total symptom severity, Immediate Postconcussion Assessment and Cognitive Test (ImPACT) composites, one-month persistent symptoms, one-month Paediatric Quality of Life (PedsQL).
Outcome measures ED visit before clinic evaluation (yes/no) served as the dependent variable.
Results ED visits were reported for 12.8% (n=25) of participants. Amnesia (36.0% vs. 10.1%; p<0.001), loss of consciousness (LOC) (20.8% vs. 6.7%; p=0.021), confusion (40.0% vs. 20.0%; p<0.0255), difficulty remembering (52.0% vs. 26.5%; p<0.0091), paresthesias (16.0% vs. 4.7%; p<0.0282), and CT imaging (60.0% vs. 0.6%; p<0.0001) were greater for the ED group. Initial symptom severity and ImPACT composite scores, and one-month outcomes of persistent symptoms and PedsQL, were no different for the ED group.
Conclusions Paediatric patients presenting to concussion clinic with 72 hours of injury who first visited an ED, have more dramatic symptoms at the TOI, yet do not appear to have any worse initial symptom severity, ImPACT scores, or one-month persistent symptoms or PedsQL than those who presented first to clinic. Future study should evaluate these relationships in larger samples.
Competing interests The current study is funded in part by the National Operating Committee on Standards for Athletic Equipment.
Ms. Fonseca is employed at the study setting.
Ms. Phillips is employed at the study setting.
Dr. Bloom is employed at the study setting.
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