Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children
Deborah A Levine1, Julia Gombar2, Taylor Lis3
1Departments of Emergency Medicine and Pediatrics, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY.
Insights
Pediatric emergency physicians face challenges diagnosing and managing concussions in young children due to age-related difficulties. Improved guidelines and tools are needed for consistent care of mild traumatic brain injuries in this population.
Area of Science:
- Pediatric Emergency Medicine
- Neuroscience
- Public Health
Background:
- Traumatic brain injury (TBI) in early childhood is common, with increasing emergency department visits.
- Postconcussive symptoms in young children are often subtle and difficult to diagnose.
- Inadequate discharge counseling can prolong symptoms and potentially cause developmental delays.
Purpose of the Study:
- To explore pediatric emergency medicine (PEM) physicians' perspectives on concussion diagnosis and management in young children (under 6 years) with mild TBI.
- To understand challenges related to terminology, diagnostic tools, and discharge counseling for pediatric concussion.
Main Methods:
- Conducted semistructured interviews with currently practicing PEM physicians using a hypothetical scenario.
- Employed snowball sampling for participant recruitment.
- Analyzed interview transcripts using thematic analysis, guided by social constructionism, with peer debriefing for refinement.
Main Results:
- Physicians utilized clinical prediction tools for neuroimaging but lacked consistent use of clinical symptom scales.
- Significant diagnostic challenges were identified due to the child's young age, limited verbal skills, and unreliable examinations.
- Difficulty in providing clear discharge instructions, including activity restrictions and educational guidance, was frequently reported.
Conclusions:
- Considerable variability exists among PEM physicians in diagnosing and managing concussions in young children.
- Underappreciation of early childhood characteristics and discomfort with symptom reliability contribute to diagnostic inconsistencies.
- There is a need for educational initiatives, age-appropriate clinical tools, and outcomes-guided research to improve care for pediatric head injuries.
Objective:
Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on "concussion" terminology, diagnosis, and management, specifically in a young child with mild TBI.
Methods:
We conducted semistructured interviews using open-ended questions involving a hypothetical scenario. We recruited currently practicing PEM physicians by a snowball sampling method. A research team recorded, transcribed, and analyzed the interviews. Using social constructionism as the philosophical framework, we developed and refined codes and derived themes until reaching thematic saturation. Peer debriefing with an expert collaborator aided with revisions of themes.
Results:
A single PEM researcher interviewed 13 participants. Three primary themes emerged. Our first theme identified the role of guidelines and tools in the diagnostic workup. Most participants utilized a clinical prediction tool for neuroimaging but no clinical symptom scales. Our second theme described the difficulties and inconsistencies in the approach to diagnosis of concussion, largely due to young age, lack of verbal skills and unreliable examinations. Our last theme focused on the difficulty in providing clear discharge instructions to parents. Many participants described difficulty providing activity restrictions, instead allowing self-modulation, and lack of counseling for educational tasks.
Conclusions:
Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.
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