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Variability in discharge instructions and activity restrictions for patients in a children's ED postconcussion

Valerie J De Maio1, Damilola O Joseph, Holly Tibbo-Valeriote

  • 1From the *Emergency Services Institute, WakeMed Health & Hospitals, Raleigh, NC; †Wake Emergency Physicians, PA; and ‡Austin/Travis County Emergency Medical Services, Austin, TX.

Pediatric Emergency Care
|December 25, 2013
PubMed

Insights

Most children with concussion in the emergency department (ED) did not receive specific discharge instructions or activity restrictions. Standardizing care is crucial for managing pediatric concussion and preventing risks from premature return to activity.

Area of Science:

  • Pediatric Emergency Medicine
  • Neurology
  • Sports Medicine

Background:

  • Concussion management in children requires careful attention to discharge instructions.
  • Standardized protocols for pediatric concussion are lacking in emergency department settings.
  • Risks of premature return to physical and cognitive activities post-concussion are significant.

Purpose of the Study:

  • To describe discharge instructions provided to school-aged children diagnosed with concussion in a pediatric emergency department (ED).
  • To identify factors associated with receiving concussion-specific discharge instructions and activity restrictions.
  • To highlight the need for improved standardization in pediatric concussion care.

Main Methods:

  • Retrospective cohort study of children aged 6-18 years evaluated for acute head trauma in a dedicated pediatric ED.
  • Inclusion criteria: ICD-9 diagnoses for head injury, concussion, or skull fracture, consistent with Zurich concussion definition.
  • Analysis of discharge data to determine rates of concussion-specific diagnoses, instructions, and activity restrictions, with univariate and multivariate analyses.

Main Results:

  • Of 218 included patients, 62% received concussion-specific discharge instructions and 34% received activity restrictions.
  • Concussion-specific instructions were more likely with loss of consciousness (OR, 1.7).
  • Activity restrictions were more likely with sport-related injury (OR, 1.31) and amnesia (OR, 1.42).

Conclusions:

  • A significant proportion of children diagnosed with concussion in the ED were discharged without specific instructions or activity limitations.
  • Improved awareness and standardization of discharge practices are essential for pediatric concussion management.
  • Addressing these gaps can mitigate risks associated with premature return to physical and cognitive activities.
Abstract

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