Concussion assessment in the emergency department: a preliminary study for a quality improvement project

Dylan A Mistry, Timothy H Rainer, Dylan A Mistry, Timothy H Rainer

Abstract

Background: In sport, concussion is assessed using the Sports Concussion Assessment Tool (SCAT) 5 and managed with return to play guidelines. Similar, user-friendly tools are rarely, if ever, used in the emergency department (ED).

Objectives: To evaluate a modified concussion assessment tool designed for the ED (ED-CAT) in patients presenting with a head injury and to identify variables that predict 30-day reattendance.

Methods: A preliminary, prospective, evaluation in a quality improvement project was conducted in one hospital in South Wales. Patients were recruited if they were over 13 years, and either did not have an ED-CT head scan or had a scan with no acute changes. The primary outcome was 30-day reattendance.

Results: 40 patients were recruited, 18 of whom had a CT scan. 37 were discharged on the same day with advice, two discharged the next day and one was admitted. Three (7.5%) patients reattended the department. Predictors of reattendance were headache score (median 3.0 vs 5.0; p<0.05), pressure in head score (2.0 vs 5.0; p<0.05), nausea/vomiting score (1.0 vs 3.0; p<0.05), dizziness score (1.0 vs 4.0; p<0.05), blurred vision score (0 vs 4.0; p<0.01), balance problems score (0 vs 4.0; p<0.05), sensitivity to light and confusion score (0 vs 4.0; p<0.01), orientation score (1. 0 vs 0; p<0.05) and immediate memory score (5.0 vs 4.0; p<0.05).

Conclusions: Key symptoms and signs predicted 30-day reattendance. The ED-CAT requires validation and refinement in a larger population to produce a short, practical, user-friendly, relevant tool for ED head injury assessment.

Keywords: concussion; diagnosis; head; sporting injuries; study.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart showing the methodology of the study.
Figure 2
Figure 2
Plan, do, study, act cycle for this quality improvement project.

References

    1. National Institute for Clinical Excellence Head injury - background information, 2016.
    1. Bazarian JJ, McClung J, Cheng YT, et al. . Emergency department management of mild traumatic brain injury in the USA. Emerg Med J 2005;22:473–7. 10.1136/emj.2004.019273
    1. Buchanan K, Slattery DE, Klauer K. 23 Emergency physician knowledge and practice habits when evaluating youth sports-related concussion in the emergency department. Ann Emerg Med 2011;58:S185 10.1016/j.annemergmed.2011.06.048
    1. Tommasone BA, Valovich McLeod TC. Contact sport concussion incidence. J Athl Train 2006;41:470–2.
    1. McCrory P, Feddermann-Demont N, Dvořák J, et al. . What is the definition of sports-related concussion: a systematic review. Br J Sports Med 2017;51:877–87. 10.1136/bjsports-2016-097393
    1. Aubry M, Cantu R, Dvorak J, et al. . Summary and agreement statement of the first international conference on concussion in sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. Br J Sports Med 2002;36:6–10.
    1. McCrory P, Meeuwisse W, Dvorak J. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016;51:838–47.
    1. The Concussion In Sport Group Sport concussion assessment tool. 5 Edn, 2017.
    1. Echemendia RJ, Meeuwisse W, McCrory P, et al. . The Sport Concussion Assessment Tool 5th Edition (SCAT5): background and rationale. Br J Sports Med 2017;51:848–50. 10.1136/bjsports-2017-097506
    1. National Institute for Clinical Excellence Head injury: assessment and early management, 2014.
    1. Stiell IG, Wells GA, Vandemheen K, et al. . The Canadian CT head rule for patients with minor head injury. The Lancet 2001;357:1391–6. 10.1016/S0140-6736(00)04561-X
    1. Duignan M, O'Connor N. Concussion management in the ED: Beyond GCS. Int Emerg Nurs 2016;26:47–51. 10.1016/j.ienj.2015.11.005
    1. Ahmed OH, Loosemore M, Hornby K, et al. . Moving concussion care to the next level: the emergence and role of concussion clinics in the UK. Prog Brain Res 2017;234:205–20. 10.1016/bs.pbr.2017.06.014
    1. Guskiewicz KM, McCrea M, Marshall SW, et al. . Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003;290:2549–55. 10.1001/jama.290.19.2549
    1. Kushner DS. Concussion in sports: minimizing the risk for complications. Am Fam Physician 2001;64:1007–14.
    1. Omalu BI, DeKosky ST, Minster RL, et al. . Chronic traumatic encephalopathy in a national football league player. Neurosurgery 2005;57:128–34. 10.1227/01.NEU.0000163407.92769.ED
    1. Mez J, Daneshvar DH, Kiernan PT, et al. . Clinicopathological evaluation of chronic traumatic encephalopathy in players of american football. JAMA 2017;318:360–70. 10.1001/jama.2017.8334
    1. Theadom A, Starkey NJ, Dowell T, et al. . Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport 2014;17:591–6. 10.1016/j.jsams.2014.02.001
    1. Kirkwood G, Parekh N, Ofori-Asenso R, et al. . Concussion in youth rugby union and rugby league: a systematic review. Br J Sports Med 2015;49:506–10. 10.1136/bjsports-2014-093774
    1. Uy P, Lee YSC, Matsuzawa Y, et al. . Predictability of the Sports Concussion Assessment Tool - Third Edition (SCAT3) on cognitive performance measures. Arch Phys Med Rehabil 2017;98:e177 10.1016/j.apmr.2017.09.091
    1. Gioia G, Collins M. Acute Concussion Evaluation ACE, 2006.
    1. Boyle A, Cleugh F, Long J, et al. . The Royal College of Emergency Medicine: Quality Improvement Guide: A practical guide for clinicians undertaking quality improvement in Emergency Departments: RCEM, 2016.
    1. Feddermann-Demont N, Echemendia RJ, Schneider KJ, et al. . What domains of clinical function should be assessed after sport-related concussion? a systematic review. Br J Sports Med 2017;51:903–18. 10.1136/bjsports-2016-097403
    1. Hänninen T, Parkkari J, Tuominen M, et al. . Sport Concussion Assessment Tool: Interpreting day-of-injury scores in professional ice hockey players. J Sci Med Sport 2017. Dec.
    1. Gardner AJ, Wojtowicz M, Terry DP, et al. . Video and clinical screening of national rugby league players suspected of sustaining concussion. Brain Inj 2017;31 1918–24. 10.1080/02699052.2017.1358399
    1. Bergman K, Louis S. Discharge instructions for concussion: are we meeting the patient needs? J Trauma Nurs 2016;23:327–33. 10.1097/JTN.0000000000000242

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi