Outcomes following Presentation with Concussion in the Paediatric Emergency Department: Missed Cases of Post-Concussion Syndrome

Background: 1 in 5 children will sustain a traumatic brain injury by the age of 16 years, with 90% of these being concussion. The majority recover to baseline function within 4 weeks, however 31% suffer from persisting symptoms. There is a lack of clear, consistent guidelines in the UK about management, discharge advice and follow-up of children with concussion. In our Paediatric Emergency department (PED) there was no follow-up arranged for any patients and no patient information leaflet.

Objectives: The aim was to identify any patients with concussion suffering from ongoing symptoms of post-concussion syndrome (PCS), who would benefit from follow-up. Additionals aims were to create an advice leaflet about concussion to be given to patients and make recommendations regarding systematic follow-up for future patients with concussion.

Methods: A search was conducted for patients aged 16 or under, discharged from the PED in the last 15 months, with a diagnosis concussion. Their medical notes were reviewed and a telephone survey of parents was conducted asking about current symptoms of PCS.

Results: The search yielded 121 patients. 68 of 121 parents of patients were able to be contacted. Of these, 33 out of 68 reported symptoms of PCS (48.53%) of new onset since their head injury, lasting longer than 4 weeks. School-aged children (5-12 years) were most commonly affected. The most common post-concussive symptoms reported were headaches, and problems with temper and impulsiveness.

Conclusion: Concussion management was found to be an area for improvement in this PED. A letter was written to the 33 children with PCS symptoms to arrange follow-up, and a new concussion leaflet for parents and patients was created to ensure follow-up was sought in the case of ongoing symptoms. Recommendations were made about the importance of starting systematic follow-up of all children with a diagnosis of concussion.