Improving Outcomes, Pediatrics

Peds Concussions last a looong time

Little Billy is a star hockey player at 13 years old.  So much so, that he is pushing the envelop and playing with the 14-16 year old class.  Billy gets checked into the glass one day and visits your ED, clearly concussed.  He’s dizzy, easily irritated by family, nauseated, and, of course, has a headache.  How long will these symptoms last? 

The Zurich Protocol suggests that most symptoms are resolved within 10 days, with 5-10% having prolonged symptoms.

However, this is the second study I’ve seen that suggests a prolonged duration in pediatrics.  This prospective cohort study of patients aged 13-18 years of age with an ED diagnosis of concussion were referred to one of 3 hospital-affilated sports medicine clinics.  The patients were evaluated using a variety of methods (neurological exam, computerized neurocognitive testing, post concussion symptom score), with duration of symptoms the main outcome.  Mean symptom duration was 44.5 days, with 48% of patients having symptoms beyond 28 days, and 13% of patients having symptoms persisting beyond 90 days (!).  Essentially, the less physically mature the patient, the longer it took for symptoms to resolve – 54.5 days vs 33.4 days to complete recovery.

Given the high likelihood that Billy will have prolonged symptoms, it would behoove those of us on the frontline to educate parents about this, and set up family expectations accordingly.

Standard

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s