Characteristics and Outcomes for Delayed Diagnosis of Concussion in Pediatric Patients Presenting to the Emergency Department

Abstract

Background: Concussions are common pediatric injuries. Previous studies have found concussed youth may be underdiagnosed in the emergency department (ED), but outcomes for those with delayed diagnosis have yet to be described.

Objective: Our aim was to compare visit characteristics and outcomes of patients who present to the ED with head injury who receive immediate vs. delayed diagnosis.

Methods: Retrospective chart review of patients aged 6 to 18 years diagnosed with concussion on their first ED or urgent care (UC) visit and patients requiring a second visit for diagnosis between July 1, 2017 and June 20, 2019. We compared demographic information, ED or UC visit features, and recovery outcomes using χ2 tests, Student's t-tests, and Wilcoxon rank-sum tests.

Results: Overall, we included 85 patients with delayed concussion diagnosis and 159 with immediate diagnosis. Those with immediate diagnosis had more symptoms inquired at initial visit (5 vs. 4; p = 0.003) and a higher likelihood of receiving concussion-specific physical examinations (80% vs. 36.5%; p < 0.001); 76.5% of delayed diagnosis patients had at least 1 symptom at follow-up visit that was not inquired about at initial visit. Those with delayed diagnosis had more medical visits during recovery (3 vs. 2; p < 0.001), longer average time to symptom resolution (21 vs. 11 days; p = 0.004), and a higher likelihood of having persistent concussion symptoms (odds ratio 2.9; 95% confidence interval 1.4-5.9).

Conclusions: Concussed children evaluated acutely for head injury who do not receive an immediate diagnosis may be at risk for persistent symptoms. Performance of a concussion-specific physical examination and use of a standardized symptom scale may aid in identification of concussed youth acutely.

Keywords: concussion; pediatric mild traumatic brain injury; persistent post-concussive symptoms; visio-vestibular examination.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Copyright © 2020 Elsevier Inc. All rights reserved.

Figures

Figure 1.

Flow diagram of patients included in the analysis

Figure 2.

Most frequent symptoms present at follow-up but not documented at initial visit in those with delayed diagnoses

Figure 3.

Survival curve for time until symptom free, stratified by delayed vs. immediate diagnosis