Citation

Taubman B, Michael Luciani A, Gealt DB, Drake TP, Cochetti P, Farrar JT. J. Concussion 2021; 5: 205970022199892.

Copyright

(Copyright © 2021, SAGE Publishing)

DOI

10.1177/2059700221998921

PMID

unavailable

Abstract

OBJECTIVE
Absent adequate randomized control trials to inform appropriate treatment for concussion in pediatric patients, guidelines have been developed based on expert opinion and observational data that may not apply to all groups. This study examines differences in the previous clinical care between concussed patients who present in pediatric practice and specialty clinics. Differences found might influence treatment recommendations for each setting.


Study design
Prospective data collected from a pediatric practice in 2011 to 2013 were compared to chart review data from two specialty clinics between 2015 and 2017. In all three groups patients 11-19 years of age with an ICD9 billing code for concussion were included if they met the 4th International Consensus definition of concussion. Patients were excluded if hospitalized or had abnormal CNS imaging.


Results
The time between injury and presentation was substantially longer in specialty clinic patients versus those seen in the primary pediatric care office. (median 10 vs. 2 days-p < 0.001) Primary care patients presenting had higher rates of immediate rest after injury, 61.4% vs 27.9% (p < 0.001). More specialty clinic patients had been seen in the emergency departments prior to presentation (47.5% vs. 18.8% p < 0.001) regardless of rest status at presentation to the office.


Conclusion
Several differences in previous clinical care between the groups were found. These included the time of presentation from injury, rates of cognitive rest both immediate and non-immediate, and emergency department visits. These differences may have implications for management recommendations. Accordingly, the appropriate treatment for patients seen by the primary pediatric care physicians may be different from those referred to specialty care. Given these findings randomized controlled trails should be conducted independently in both groups of patients.

Language: en