Discharge Instructions for Youth Sports-Related Concussions in the Pediatric Emergency Department 2004-2012

Monday, October 28, 2013: 2:45 PM
Florida Ballroom A (Hyatt Regency Orlando, formerly the Peabody)
Mark F Riederer, MD1, Joseph Boyle2, Clint Morgan2, Elise Martin2, Allison Umfress2, Cameron Upchurch2, George Yang2, Ben Saville, Ph.D.3 and Zengqi Lu4, (1)The Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, (2)Vanderbilt University School of Medicine, Nashville, TN, (3)Department of Biostatistics, Vanderbilt University School of Medicine, Nashville,, TN, (4)Pediatrics, Vanderbilt University Medical Center, Nashville, TN

Purpose

To determine if the 2010 CDC recommendations on management of concussions and the development of a dedicated sports concussion center has improved discharge recommendations for youth SRC seen in the pediatric emergency department.

Methods

A retrospective chart review was conducted on patients evaluated in the pediatric emergency department from January 2004 to July 2012.  Patients were selected by ICD9 code for having a concussion during a sporting activity.  Discharge instructions were reviewed for recommendations for cognitive rest, physical rest, PCP follow up, and referral to a concussion specialist or center.  An appropriate discharge was defined as having some type of rest and provider follow-up.  Logistic regression was used for statistical analysis.

Results

There were 497 youth SRC from 392,908 total ED visits, 20 of which were excluded due to lack of documentation.  Overall, only 66% had appropriate discharge recommendations.  This improved to 75% after 2010, which was not found to be statistically significant (OR 1.02, p=0.179).  Recommended physical rest instructions remained constant over the time period.  Only 4% had some type of recommended cognitive rest, which only increased to 12% of the patients seen after 2010.  Factors that were found to be statistically significant in receiving better discharge recommendations include children who were older (OR=1.10, p=0.010), boys (OR=1.70, p=0.027), and if a head CT was performed (OR=1.01, p=0.018).  Lastly, referrals to a sports concussion specialist or center dramatically increased from an average of 8% to 43% after 2010.

Conclusion

Even with the 2010 CDC Heads-Up campaign on concussion education, appropriate discharge recommendations for youth SRC have not improved.  Although providers frequently recommend physical rest, recommendations for cognitive rest remains low.  Children who are diagnosed with SRC are likely continuing to participate in cognitive activities (returning to school, reading, watching TV, texting, etc.) with lack of recommended rest.  Fortunately, more referrals are being made to sports concussion specialists where appropriate ongoing concussion management can be instituted.