Parental Knowledge of Concussion

Friday, October 10, 2014
San Diego Ballroom C (San Diego Marriott Marquis )
Kirstin D. Weerdenburg, M.D., Suzan Schneeweiss, M.D., Ellen Koo and Kathy Boutis, M.D., Hospital for Sick Children, Toronto, ON, Canada

Purpose:   Since concussions commonly occur during play and sport, parents may have a key role in identification, and advocating for sport removal and assessment by a physician. However, information on parental knowledge of recognizing and understanding concussion is currently very limited. We determined the proportion of parents who identified concussion as an injury to the head that causes non-hemorrhagic brain injury and presents with brain-related symptoms. We also examined the association between parental knowledge of concussion and their demographic variables, parental awareness of appropriate actions if concussion is suspected, and compared parent versus physician diagnosis of concussion for the child’s head injury.

Methods:   Parents of children aged 5-18 years presenting to a pediatric emergency department within 2 weeks of a head injury were asked to participate in a 24-item questionnaire. Survey questions were derived and validated using expert opinion, available literature, and pre- and pilot-testing of questions on the target audience.  

Results: Of 593 eligible parents, 511 (86.2%) were enrolled. Of these, 350 (68.4%) were female, 411 (80.5%) were aged 31-50 years, 437 (85.5%) had post-secondary education, and 370 (72.5%) reported a history of participation in an organized sport.  Importantly, 242 (47.7%; 95% CI 43.4, 52.1) parents correctly identified concussion as an injury to the head that causes non-hemorrhagic brain injury and presents with brain-related symptoms. There were no parental demographics (age, sex, education, prior history of organized sport participation) that were significantly predictive of concussion knowledge. Of the respondents, 40.0% believed their child's current head injury may be a concussion, while physician diagnosed concussion for this population was 29.3% (p = 0.45). The inter-rater agreement between physicians and parents in labeling the child's head injury as a concussion was poor, kappa = 0.011. If a parent thought their child had a concussion, 460 (91.5%) would appropriately stop the child's play and see a physician. Although 502 (98.2%) understood that a concussion would lead to restricted activities for the child, only 135 (26.4%) were familiar with Return-to-Play guidelines.

Conclusion: About 50% of parents were able to correctly identify concussion, but the correlation between physician and parent perception of diagnosis of concussion was poor. Furthermore, most parents were aware of proper immediate actions once a head injury occurred but were not aware of Return-to-Play guidelines. These results support the strengthened recommendation of an early physician visit to provide families with an assessment for the correct diagnosis and to educate families on appropriate anticipatory guidance and follow up for their child’s injury.