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Poor Adherence to Discharge Instructions for Pediatric Concussion

August 4, 2014

Poor Adherence to Discharge Instructions for Pediatric Concussion

  1. Katherine Bakes, MD

Of patients who returned to activities 2 weeks after emergency-department discharge, 35% reported continued concussive symptoms.

  1. Katherine Bakes, MD

Prior studies have shown that adolescent athletes with concussions often do not follow guidelines governing when they can return to play. To further examine this issue, investigators conducted a prospective cohort study of 150 pediatric patients (median age, 13 years) diagnosed with concussion during a 1-year period at a single pediatric emergency department (ED).

At discharge, patients received instructions developed from the third international Consensus Statement on Concussion in Sport. Follow-up phone surveys assessing nonadherence — returning to play or normal activities on or before resolution of symptoms or without medical clearance — were completed by 83% of patients at 2 weeks and by 77% at 4 weeks.

Results were as follows:

  • 39% reported returning to play on the same day as the injury.

  • Of the 44% who returned to activities at 2 weeks, 58% had not received medical clearance and 35% were still symptomatic.

  • Of the 64% who returned to activities at 4 weeks, 46% had not received medical clearance and 23% were symptomatic.

  • Patients with sports concussions were more likely than those with non-sports concussions to have received medical clearance before returning to play at 2 weeks (54% vs. 20%), but not at 4 weeks.

  • Returning to play with symptoms and without medical clearance was not associated with age.

Comment

Despite a national campaign to improve long-term outcomes from pediatric concussions, adherence to discharge instructions is dismal. ED providers can be a strong voice in educating parents and, at discharge, should stress the importance of compliance with guidelines.

  • Disclosures for Katherine Bakes, MD at time of publication Grant / Research support Department of Justice Editorial boards Elsevier Emergency Medicine Secrets

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