Clinical Pediatrics http://cpj.sagepub.com/
Short-term Outcomes of Sport- and Recreation-Related Concussion in Patients Admitted to a Pediatric Trauma Service Harry Bramley, Carol Mcfarland, Mechelle M. Lewis, Michele L. Shaffer, Robert Cilley, Brett Engbrecht, Mary Santos, Susan Rzucidlo, Beverly Shirk, Lynn Simmons and Mark S. Dias CLIN PEDIATR published online 1 May 2014 DOI: 10.1177/0009922814533403 The online version of this article can be found at: http://cpj.sagepub.com/content/early/2014/04/30/0009922814533403
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research-article2014
CPJXXX10.1177/0009922814533403Clinical PediatricsBramley et al
Article
Short-term Outcomes of Sport- and Recreation-Related Concussion in Patients Admitted to a Pediatric Trauma Service
Clinical Pediatrics 1–7 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814533403 cpj.sagepub.com
Harry Bramley, DO1, Carol Mcfarland2, Mechelle M. Lewis, PhD2, Michele L. Shaffer, PhD3,4, Robert Cilley, MD1, Brett Engbrecht, MD, MPH1, Mary Santos, MD1, Susan Rzucidlo, RN1, Beverly Shirk, RN1, Lynn Simmons, RN1, and Mark S. Dias, MD1
Abstract The outcomes of patients admitted to the hospital following a sport-related concussion are largely unknown. Medical records of patients admitted to the pediatric trauma service between 2008 and 2011 after sustaining a sport-related concussion were reviewed. In all, 59 participants were in the high-velocity activities group, and 21 in the field or court sport group. Abnormal CT scans were found in 14 patients in the high-velocity group and 2 in the field or court sport group. The majority of participants in the field or court sport group were football players, all of whom had normal CT scans. Headache was predictive of an abnormal CT scan. Among the patients, 56% clinically improved and were discharged the following day. Patients with field or court sport–related concussion admitted to a pediatric trauma service appear to be at low risk for clinically significant intracranial pathology and do well in the acute setting. Keywords mild traumatic brain injury, concussion, computed tomography, sports injury, Glasgow Coma Scale
Introduction Traumatic brain injury (TBI), defined as an alteration in brain function or other evidence of brain pathology caused by external forces, is a leading cause of morbidity and mortality in the pediatric population.1-3 Mild TBI (mTBI) or concussion is defined as a trauma-related, short-lived, and generally completely reversible impairment of neurological function that resolves spontaneously, usually without neuroimaging abnormalities.4 However, there is a 10% risk for intracranial abnormalities in patients identified as having a mTBI, and a 1% risk of hemorrhage requiring immediate neurosurgical interventions.5,6 The acute management of mTBI requires recognition of these abnormalities in a timely manner because a delay may increase morbidity and mortality. Athletics is a large part of childhood. Approximately 60% of high school students participate in at least 1 organized sport, and many younger children are active in multiple sports.7 Participation in recreational sports is also common in the pediatric population, further
increasing the number of children involved in sports. From 2001 to 2005, an estimated 502 000 emergency department (ED) visits for concussion occurred in children from the ages of 8 to 19 years.8 Research regarding sport-related concussion has increased significantly since 1999, and several organizations have published position statements regarding the identification, management, and prevention of sport-related TBI.4,9-11
1
Penn State Milton S. Hershey Medical Center, Hershey, PA, USA Penn State College of Medicine, Hershey, PA, USA 3 Children's Core for Biomedical Statistics, Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA, USA 4 Department of Pediatrics, University of Washington, Seattle, WA, USA 2
Corresponding Author: Harry Bramley, Penn State Milton S. Hershey Medical Center, Department of Pediatrics, Mail Code H085, 500 University Drive, Hershey, PA 17033, USA. Email:
[email protected]
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Clinical Pediatrics
Between 15% and 70% of children who present to an ED with a head injury will undergo neuroimaging with a CT scan, though >90% will not have a significant abnormality.12-14 The lifetime risk of cancer attributable to radiation from CT scans has received increasing attention, and recent reports have cautioned against the liberal use of CT scans, particularly in children.15,16 Recently published guidelines suggest mandatory CT scans for pediatric patients with mTBI and Glasgow Coma Scale (GCS) score
