Pediatric sport and nonsport concussions presenting to emergency departments: injury circumstances, characteristics, and clinical management

Author:

Rausa Vanessa C.12,Borland Meredith L.34,Kochar Amit56,Phillips Natalie78,Gilhotra Yuri7,Dalton Sarah9,Cheek John A.121011,Furyk Jeremy121314,Neutze Jocelyn15,Davis Gavin A.116,Anderson Vicki11718,Williams Amanda1,Dalziel Stuart R.1920,Hearps Stephen J. C.1,Babl Franz E.121021

Affiliation:

1. Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia;

2. Departments of Paediatrics and

3. Emergency Department, Perth Children’s Hospital, Perth, Western Australia, Australia;

4. School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia;

5. Emergency Department, Women’s & Children’s Hospital, Adelaide, South Australia, Australia;

6. Department of Acute Care Medicine, University of Adelaide, South Australia, Australia;

7. Emergency Department, Queensland Children’s Hospital, Brisbane, Queensland, Australia;

8. Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia;

9. Emergency Department, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia;

10. Emergency Department, The Royal Children’s Hospital, Melbourne, Victoria, Australia;

11. Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia;

12. Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia;

13. Emergency Department, University Hospital Geelong, Victoria, Australia;

14. School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia;

15. Emergency Department, Kidz First Middlemore Hospital, Auckland, New Zealand;

16. Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria, Australia;

17. School of Psychological Sciences, University of Melbourne, Victoria, Australia;

18. Psychology Service, Royal Children’s Hospital, Melbourne, Victoria, Australia;

19. Emergency Department, Starship Children’s Health, Auckland, New Zealand; and

20. Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, New Zealand

21. Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia;

Abstract

OBJECTIVE The aim of this study was to compare injury circumstances, characteristics, and clinical management of emergency department (ED) presentations for sports-related concussion (SRC) and non-SRC. METHODS This multicenter prospective observational study identified patients 5–17 years old who presented to EDs within 24 hours of head injury, with one or more signs or symptoms of concussion. Participants had a Glasgow Coma Scale score of 13–15 and no abnormalities on CT (if performed). Data were stratified by age: young children (5–8 years), older children (9–12 years), and adolescents (13–17 years). RESULTS Of 4709 patients meeting the concussion criteria, non-SRC accounted for 56.3% of overall concussions, including 80.9% of younger child, 51.1% of older child, and 37.0% of adolescent concussions. The most common mechanism of non-SRC was falls for all ages. The most common activity accounting for SRC was bike riding for younger children, and rugby for older children and adolescents. Concussions occurring in sports areas, home, and educational settings accounted for 26.2%, 21.8%, and 19.0% of overall concussions. Concussions occurring in a sports area increased with age, while occurrences in home and educational settings decreased with age. The presence of amnesia significantly differed for SRC and non-SRC for all age groups, while vomiting and disorientation differed for older children and adolescents. Adolescents with non-SRC were admitted to a ward and underwent CT at higher proportions than those with SRC. CONCLUSIONS Non-SRC more commonly presented to EDs overall, with SRC more common with increasing age. These data provide important information to inform public health policies, guidelines, and prevention efforts.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Reference29 articles.

1. What is the difference in concussion management in children as compared with adults? A systematic review;Davis GA,2017

2. Point of health care entry for youth with concussion within a large pediatric care network;Arbogast KB,2016

3. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022;Patricios JS,2023

4. What domains of clinical function should be assessed after sport-related concussion? A systematic review;Feddermann-Demont N,2017

5. Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review;Schneider KJ,2023

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