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Admission of Pediatric Concussion Injury Patients: Is It Necessary?
Erika B Lindholm1, Roshan D'Cruz2, Romulo Fajardo3
1Division of Pediatric General, Thoracic and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Insights
Pediatric concussion patients with negative head CT scans rarely need admission. Most can be safely discharged home if they can tolerate a diet, reducing unnecessary hospital stays.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Management
Background:
- There is no established consensus on managing pediatric concussion patients with negative head CT scans.
- Evaluating the necessity of hospital admission for these patients is crucial.
Purpose of the Study:
- To determine if pediatric patients with concussion symptoms and a negative head CT scan require routine hospital admission.
- To inform clinical decision-making regarding the disposition of these patients.
Main Methods:
- Retrospective chart review of pediatric trauma patients admitted for concussion from 2010-2017.
- Inclusion criteria: negative head CT scan.
- Data reviewed: demographics, ED evaluation, and hospital course.
Main Results:
- 90 pediatric patients (10 years avg. age, 72.2% male) with negative head CTs were analyzed.
- 94.4% of admitted patients were discharged within 24 hours.
- Only 4.4% stayed longer than 24 hours, with only two cases directly related to concussion management (diet intolerance).
Conclusions:
- Most pediatric concussion patients with negative head CT scans do not require hospitalization.
- Safe discharge home is possible for patients who tolerate a diet, optimizing resource utilization and patient care.
Background:
Currently there is no consensus on the management of patients with a concussion and negative computed tomography (CT) of the head. This study examined the necessity of admitting pediatric patients with concussive symptoms. The purpose of this study was to determine if pediatric patients evaluated in the emergency department (ED) for concussion with a negative head CT scan require routine hospital admission.
Materials And Methods:
A retrospective chart review of pediatric trauma patients admitted to the hospital for a concussion from 2010 to 2017 was conducted after IRB approval (1709005621). Only patients with a negative head CT were included. Demographic information, ED evaluation, and hospital course were reviewed.
Results:
A total of 90 patients (Mage = 10 y; 72.2% male) were included in the analysis. The average Glasgow coma scale was 14.6 (range 9-15). Loss of consciousness was reported by 36.7% (n = 33) of patients. Reported symptoms included nausea/emesis in 35.5% (n = 32) and altered mental status in 40% (n = 36). Following admission, 94.4% of patients were discharged within 24 h of admission. Of the four patients (4.4%) that stayed longer than 24 h, only two hospitalizations were related to the concussion (inability to tolerate diet). One patient had a fever unrelated to the concussion and one stayed because of social issues. Average length of stay for these patients was 2.75 d (range 2-4 d). There was no difference in Glasgow coma scale in comparison to patients who were discharged within 24 h.
Conclusions:
Although there are a large number of pediatric patients evaluated in the ED for concussion injuries, very few of these patients require any further care. Our study suggests that patients with concussion and a negative head CT who tolerate a diet can be safely discharged home.
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