Tag Archives: ER
Pediatrics, the official journal of the American Academy of Pediatrics, has released the findings of a provocative new study, which suggests the severity of symptoms in a child that has suffered a concussion is unrelated to how long it will take the child to recover from those symptoms.
What follows is an abstract of the study, published by Prediatrics:
BACKGROUND AND OBJECTIVES: Up to 30% of children who have concussion initially evaluated in the emergency department (ED) display delayed symptom resolution (DSR). Greater initial symptom severity may be an easily quantifiable predictor of DSR. We hypothesized that greater symptom severity immediately after injury increases the risk for DSR.
METHODS: We conducted a prospective longitudinal cohort study of children 8 to 18 years old presenting to the ED with concussion. Acute symptom severity was assessed using a graded symptom inventory. Presence of DSR was assessed 1 month later. Graded symptom inventory scores were tested for association with DSR by sensitivity analysis. We conducted a similar analysis for post-concussion syndrome (PCS) as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Potential symptoms characteristic of DSR were explored by using hierarchical cluster analysis.
RESULTS: We enrolled 234 subjects; 179 (76%) completed follow-up. Thirty-eight subjects (21%) experienced DSR. Initial symptom severity was not significantly associated with DSR 1 month after concussion. A total of 22 subjects (12%) had PCS. Scores >10 (possible range, 0–28) were associated with an increased risk for PCS (RR, 3.1; 95% confidence interval 1.2–8.0). Three of 6 of the most characteristic symptoms of DSR were also most characteristic of early symptom resolution. However, cognitive symptoms were more characteristic of subjects reporting DSR.
CONCLUSIONS: Greater symptom severity measured at ED presentation does not predict DSR but is associated with PCS. Risk stratification therefore depends on how the persistent symptoms are defined. Cognitive symptoms may warrant particular attention in future study. Follow-up is recommended for all patients after ED evaluation of concussion to monitor for DSR.
Over the past 12 months, concussion awareness has heightened primarily because of the health-related after-effects experienced by what now seems to be a never-ending amount of complaints filed on behalf of former professional sports athletes. This awareness is now going through a trickle-down phase, exposing similar issues in college, high school, and youth sports in general.
But a concussion doesn’t have to result from a sports injury. Children, everyday, have accidents that lead toward concussions where no sport is involved.
Current emergency room data from a study, whose lead author, Dr. Jeffrey Colvin, is a pediatrician at Children’s Mercy Hospitals and Clinics in Kansas City, indicates a significant increase in the diagnoses of child concussions. At the same time though, the number of kids being hospitalized following concussion diagnoses declined during this same ten year study.
In effect, the increase in ER visits appears to be a result of ‘the word on the street’—more people have now become informed of the lurking dangers of concussions.
Another recent study shows an increase in “child” athletes receiving hospital treatment for head injuries. Again, this is thought to be a result of awareness, not an actual increase in concussions.
According to Colvin, a decade ago, concussions were treated as a “ding.” There was nothing to worry about. However, that mindset has changed in the face of ongoing concussion research amid concerns over what repeat concussions might cause later on in life.
A study analyzing medical records from 2001-2010, taken from more than a dozen children’s hospitals nationwide, revealed that ER doctors reported 2,126 concussions in children 18 and younger in 2001. That statistic rose to 4,967 in 2010.
At the outset of this study, approximately 25 percent of the kids were hospitalized for treatment of concussions. That number dropped to about 9 percent in 2010.
In a brief report prepared by Colvin to be presented at a Pediatrics Academic Societies meeting in Boston, it appears that 170,000 U.S. kids are admitted to ERs annually for treatment of head injuries. The major causes for kids’ concussions are sports, falls, and traffic accidents.
Confirming Colvin’s interpretation of the data from his study is Dr. Rebecca Carl. As a sports medicine specialist at Children’s Memorial Hospital in Chicago, she states that her hospital has also seen increases in ER visits. This is due in some respects to Illinois legislation requiring that athletes who are removed from play be evaluated by a doctor.