儿科脑震荡患者是否遵守出院医嘱？

Are pediatric concussion patients compliant with discharge instructions?

机构信息

From the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, Virginia.

出版信息

J Trauma Acute Care Surg. 2014 Jul;77(1):117-22; discussion 122. doi: 10.1097/TA.0000000000000275.

DOI:10.1097/TA.0000000000000275

PMID:24977765

Abstract

BACKGROUND

Concussions are commonly diagnosed in pediatric patients presenting to the emergency department (ED). The primary objective of this study was to evaluate compliance with ED discharge instructions for concussion management.

METHODS

A prospective cohort study was conducted from November 2011 to November 2012 in a pediatric ED at a regional Level 1 trauma center, serving 35,000 pediatric patients per year. Subjects were aged 8 years to 17 years and were discharged from the ED with a diagnosis of concussion. Exclusion criteria included recent (past 3 months) diagnosis of head injury, hospital admission, intracranial injury, skull fracture, suspected nonaccidental trauma, or preexisting neurologic condition. Subjects were administered a baseline survey in the ED and were given standardized discharge instructions for concussion by the treating physician. Telephone follow-up surveys were conducted at 2 weeks and 4 weeks after ED visit.

RESULTS

A total of 150 patients were enrolled. The majority (67%) of concussions were sports related. Among sports-related concussions, soccer (30%), football (11%), lacrosse (8%), and basketball (8%) injuries were most common. More than one third (39%) reported return to play (RTP) on the day of the injury. Physician follow-up was equivalent for sport and nonsport concussions (2 weeks, 58%; 4 weeks, 64%). Sports-related concussion patients were more likely to follow up with a trainer (2 weeks, 25% vs. 10%, p = 0.06; 4 weeks, 29% vs. 8%, p < 0.01). Of the patients who did RTP or normal activities at 2 weeks (44%), more than one third (35%) were symptomatic, and most (58%) did not receive medical clearance. Of the patients who had returned to activities at 4 weeks (64%), less than one quarter (23%) were symptomatic, and most (54%) received medical clearance.

CONCLUSION

Pediatric patients discharged from the ED are mostly compliant with concussion instructions. However, a significant number of patients RTP on the day of injury, while experiencing symptoms or without medical clearance.

LEVEL OF EVIDENCE

Care management, level IV. Epidemiologic study, level III.

摘要

背景

在急诊科（ED）就诊的儿科患者中，经常会诊断出脑震荡。本研究的主要目的是评估对 ED 出院时脑震荡管理指导的遵守情况。

方法

这是一项于 2011 年 11 月至 2012 年 11 月在一家地区一级创伤中心的儿科 ED 进行的前瞻性队列研究，每年为 35000 名儿科患者提供服务。研究对象年龄为 8 至 17 岁，从 ED 出院时诊断为脑震荡。排除标准包括最近（过去 3 个月内）有头部损伤、住院、颅内损伤、颅骨骨折、疑似非意外创伤或先前存在的神经疾病。研究对象在 ED 进行基线调查，并由主治医生提供标准化的脑震荡出院指导。在 ED 就诊后 2 周和 4 周进行电话随访调查。

结果

共纳入 150 例患者。大多数（67%）脑震荡与运动有关。在运动相关的脑震荡中，最常见的损伤是足球（30%）、橄榄球（11%）、长曲棍球（8%）和篮球（8%）。超过三分之一（39%）的患者在受伤当天恢复运动（RTP）。运动性和非运动性脑震荡的医生随访情况相当（2 周时，58%；4 周时，64%）。运动性脑震荡患者更有可能在受伤后 2 周时咨询教练（2 周时，25%比 10%，p=0.06；4 周时，29%比 8%，p<0.01）。在 2 周时进行 RTP 或正常活动的患者中（44%），超过三分之一（35%）有症状，大多数（58%）未获得医学许可。在 4 周时恢复活动的患者中（64%），不到四分之一（23%）有症状，大多数（54%）获得了医学许可。