Evaluation of Emergency Medicine Discharge Instructions in Pediatric Head Injury
Matthew J Sarsfield MD, Eric J Morley MD MS, James Callahan MD, William Grant EdD and Susan Wojcik MS
Study Objectives: Pediatric head trauma is a common occurrence. There is mounting evidence that even minor head injury patients require limits on school activities and/or removal from sports and play to help speed recovery and limit morbidity. The objective of this study was to determine whether discharge instructions given to children who had sustained head injuries included information regarding activity restrictions, activity time constraints, and/or specifics of follow-up care.
Methods: This was a retrospective chart review of patients aged 2-18 years evaluated and treated for head injury during a 4-month period at a level 1 trauma center (volume ~23,000 pediatric patients per year). Included were those children seen, evaluated, and diagnosed with any of the following: mild head injury, concussion, minor head trauma, or mild traumatic brain injury. Subjects were excluded if there was a positive acute head injury CT finding (other than findings of a simple linear skull fracture) or if the subject required admission.
Results: Among the 204 patients meeting eligibility 95.1% received instruction to follow-up with a physician, 82.8% received anticipatory guidance regarding expected symptoms, 15.2% received specific restriction time from sports, and 21.5% were removed from sports. Of these patients, 113 patients were determined "likely" to have sustained a concussion. Patients with sports-related concussion received return-to-sports restrictions (chi square = 11.225, p <0.008) and to remove the child from play (chi square = 9.781, p < 0.004) as discharge instructions significantly more than patients with MVA or other mechanisms of injury.
Conclusion: Children sustaining head injury were inadequately instructed to restrict athletic activities upon discharge. This is particularly true for patients who sustain a concussion from non-sports related activity.