Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Sleep and Childhood Concussion - Brain Injury. Often Problematic. Often Overlooked.

Following brain injury, sleep disorders are often overlooked in the care of children, teens and young adults. JR
Sleep disorders in children with traumatic brain injury: a case of serious neglect

1. Gregory Stores^1,* and
2. Rachel Stores²

Article first published online: 12 MAY 2013

"Findings in the following recent studies illustrate the frequent persistence of disturbed sleep, which clearly has implications for rehabilitation. Castriotta et al.[9] reported the presence of sleep disturbance in 46% of adult patients at least 3 months after TBI; Baumann et al.[10]described 72% of adults with TBI as having sleep disturbances 6 months after the injury that were not present before the accident; Fogelberg et al.[11] found persistent sleep difficulties in 44% of rehabilitation patients 1 year after TBI, and in the subsequent study by Baumann's group[12] such sleep problems were shown to be still present 3 years after injury in two-thirds of patients.

Studies of TBI and sleep disturbance in children are few, and the findings can be inconsistent.

 Using retrospective parental reports for pre-injury sleep and repeated prospective post-injury assessments up to 2 years, Beebe et al.[13] described children aged 6 to 12 years with severe TBI as being at increased risk for post-injury sleep problems compared with those with moderate TBI and a comparison group of children with only an orthopaedic injury. I

n contrast, a small group of 7- to 12-year-old children with a mild TBI 6 months before assessment were said to have greater sleep disturbance than children with orthopaedic injuries.[14] 

In a small-scale study, Kaufman et al.[15] found that adolescents who had suffered a minor head injury 3 years previously still complained of severe sleep disturbances and showed polysomnographic and actometry results in keeping with their complaints. 

Subsequently, researchers from the same group followed a larger number of adolescents who had suffered a minor head injury up to 6 years previously, and found that over a quarter still had subjective sleep disturbance.[16]

A more recent prospective study over 2 years of children aged up to 17 years of age who had experienced TBI confirmed a higher rate of sleep disturbance (with more prolonged duration) than comparison children who had experienced an orthopaedic injury.[17] 

Risk factors included pain, psychosocial factors, and mild TBI, which has been reported to be possibly more closely correlated with an increased likelihood of sleep disturbance than severe forms of TBI.[18] The counter-intuitive recurrent theme that mild TBI particularly seems to predispose to sleep disturbance is just one of the many current imponderables in this area of enquiry."

Aim

The aim of this study was to review the basic aspects of sleep disturbance in children with traumatic brain injury (TBI).

Method

A search was performed on reports of sleep disturbances in children who had suffered TBI. Adults with TBI were also considered to anticipate the nature and significance of such disturbances in younger patients. Types of reported sleep disturbance were noted and their possible aetiology and management considered.

Results

Sleep disturbance has consistently been associated with TBI but the literature suggests that this aspect of patient care is often inadequately considered and there has been little research on the subject, especially in relation to children. Excessive daytime sleepiness is often mentioned, less so insomnia and parasomnias, but there is little information about the specific sleep disorders underlying these problems.

Interpretation

Sleep disorders with potentially important developmental consequences have been neglected in the care of children with TBI. Screening for sleep problems should be routine and followed, if indicated, by a detailed diagnosis of the child's underlying specific sleep disorder, the possible aetiology of which includes neuropathology and potential medical, psychological, or psychiatric comorbidities. Appropriate assessments and modern treatment options are now well defined although generally underutilized. Further well-designed research is needed for which guidelines are available.

LINK to Full Article HERE

Guidelines for pediatric concussion

Comprehensive guidelines for pediatric concussion are now available.

Pediatric emergency medicine researchers at the Children's Hospital of Eastern Ontario (CHEO) together with the Ontario Neurotrauma Foundation (ONF) today launch the first comprehensive pediatric concussion guidelines.

"There have been recommendations and policies on concussion available in the past, but they tend to have focused on sports-related injury and not on children and youth," said Dr. Roger Zemek, project leader, scientist at CHEO, and Assistant Professor of Pediatrics and Emergency Medicine at the University of Ottawa. "We've developed a reliable resource that is valuable for everyone affected by pediatric concussion: from children and their families, to health care providers, and to schools and recreational organizations. This is so important because children get more concussions than adults do, with increased risk because their brains are still developing."

The pediatric guidelines were initiated by ONF, managed by CHEO, and developed by an expert panel including over 30 members across Canada and the United States led by Dr. Roger Zemek. The project team included representation from the full spectrum of pediatric health disciplines (emergency medicine, family practitioners, neurologists, rehabilitation professionals, etc.) It took over 2 years to review more than 4,000 academic papers, and numerous meetings, to create the first comprehensive pediatric concussion guidelines for healthcare professionals, parents and/or caregivers, schools and/or community sports organizations.

These new guidelines provide healthcare providers with evidence-based recommendations to standardize the diagnosis and management of concussion in children aged 5 to 18 years old, from the initial assessment through to the period of recovery (which might last months.) Furthermore, it fills a need to standardize the reintegration into school and social activities, both of which are crucial to children and adolescents during their formative years.

"These are the first comprehensive pediatric guidelines that we're aware of; they reflect the very best available evidence today," said Dr. Zemek. "It was fascinating to see how recommendations have changed over time. Years ago, children were told to 'rest' after concussion, which means something entirely different today with the onset of technology -- now, rest also includes a break from screen time."

The guidelines include numerous tools and clear instructions for all levels of user. For example, the guidelines provide a pocket tool to be used by a coach or parent at the sideline to recognize concussion and offer advice on when to remove kids from play and when to seek emergent medical attention. For the emergency department physician, algorithms are provided to guide the decision whether or not to obtain CT scans, and examples of written discharge handouts for patients and families are included. For family physicians and nurse practitioners in the community, the guidelines provide recommendations for ongoing symptom management and decision tools to help navigate 'return-to-learn' and 'return-to-play'. For school boards, the guidelines provide an example of a policy statement regarding pediatric concussion.

"These guidelines are exceedingly clear and comprehensive. I think this will be an indispensable resource for caregivers in a wide range of care settings, and also be accessible for the general public," said Rebekah Mannix, MD, MPH, Assistant Professor of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.

The guidelines are free and available at http://www.onf.org/documents/guidelines-for-pediatric-concussion and http://www.concussionsontario.org/guidelines-for-pediatric-concussion

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