The Diagnosis of Concussion in Pediatric Emergency Departments: A Prospective Multicenter Study

Publication date: June 2018
Source:The Journal of Emergency Medicine, Volume 54, Issue 6
Author(s): Kathy Boutis, Jocelyn Gravel, Stephen B. Freedman, William Craig, Ken Tang, Carol A. DeMatteo, Alexander Sasha Dubrovsky, Darcy Beer, Emma Burns, Gurinder Sangha, Roger Zemek
BackgroundThe accurate identification of children with a concussion by emergency physicians is important to initiate appropriate anticipatory guidance and management.ObjectivesWe compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion.MethodsThis was a planned secondary analysis of a prospective, multicenter cohort study. Participants were 5–17 years of age and met the Zurich/Berlin International Consensus Statement criteria for concussion.ResultsThere were 2946 enrolled children. In those with physician-diagnosed concussion vs. no concussion, the frequency of persistent symptoms was 62.5% vs. 38.8% (p < 0.0001) at 1 week, 46.3% vs. 25.8% (p < 0.0001) at 2 weeks, and 33.0% vs. 23.0% (p < 0.0001) at 4 weeks. Of those meeting international criteria, 2340 (79.4%) were diagnosed with a concussion by an emergency physician and 12 variables were associated with this diagnosis. Five had an odds ratio (OR) > 1.5: older age (13–17 vs. 5–7 years, OR 2.9), longer time to presentation (≥16 vs. <16 h, OR 2.1), nausea (OR 1.7), sport mechanism (OR 1.7), and amnesia (OR 1.6).ConclusionsRelative to international criteria, the more selective assignment of concussion by emergency physicians was associated with a greater frequency of persistent concussion symptoms. In addition, while most children meeting international criteria for concussion were also provided this diagnosis for concussion by an emergency physician, the presence of 5 specific variables made this diagnosis more likely.



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