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Pediatric minor head injury related return visits to the emergency department and their outcome
Rajan Arora1, Meghna Shukla2, Elizabeth McQuillen3
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI, United States of America.
Insights
Pediatric minor head injuries (MHI) have a low return visit rate to the emergency department (ED). Most children with MHI have good outcomes upon revisit, with few requiring significant intervention.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Outcomes Research
Background:
- Minor head injury (MHI) is a frequent reason for pediatric emergency department (ED) visits.
- Most children with MHI are safely discharged without imaging.
- Data on the frequency and outcomes of return visits (RVs) for MHI in children is limited.
Purpose of the Study:
- To determine the frequency of unscheduled return visits for MHI in a pediatric ED.
- To describe the outcomes of these pediatric MHI return visits.
Main Methods:
- Retrospective review of the ED RV database.
- Inclusion criteria: patients <18 years with MHI presenting within 72 hours of index visit for head injury complaints.
- Data collected on patient demographics, revisit reasons, interventions, and outcomes.
Main Results:
- The return visit rate for MHI was approximately 1% (61/6225).
- Most revisits (55.7%) were by females, and 85.5% were in the 2-17 year age group.
- Three-fourths of revisits were for concussion symptoms; nearly two-thirds required interventions, but missed traumatic brain injury was rare.
Conclusions:
- Return visits for pediatric MHI are infrequent.
- These revisits are generally associated with favorable outcomes.
- A small percentage of revisits may be potentially avoidable.
Background:
Minor head injury (MHI) in children is a common emergency department (ED) presentation. It is well established that majority of these patients don't require imaging and can be safely discharged. What is less known is how often these children come back to the ED and the outcome of their revisits? The objective of this study was to describe the frequency and outcome of unscheduled return visits (RVs) for MHI in a pediatric ED.
Methods:
A retrospective chart review of emergency department RV's database was conducted from August 2016 to July 2019. MHI patients <18 years of age who came back to the ED within 72 h of their index visit - for head injury related complaints - were eligible for inclusion.
Results:
Return visit rate for MHI was around 1% (61/6225). Of these, 55.7% (34/61) were female and 85.5% (53/61) were in the age group 2-17 years. Three-fourths of the revisits were for concussion-related symptoms. Nearly two-thirds of the patients required one or more interventions upon revisit. Missed clinically important traumatic brain injury was rare. Only one patient required operative intervention upon revisit. Though largely unpreventable, 5% (3/61) of the revisits were deemed potentially avoidable.
Conclusion(S):
RVs secondary to MHI in children remain low and are associated with good outcomes.
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