Discharge instructions for youth sports-related concussions in the emergency department, 2004 to 2012.

OBJECTIVE

To evaluate the effect of the Centers for Disease Control and Prevention (CDC) Heads-Up concussion campaign on appropriateness of discharge instructions for youth sports-related concussion (SRC) patients presenting to a pediatric emergency department (ED).

DESIGN

Retrospective cohort study.

SETTING

Pediatric ED.

PATIENTS

Children up to 18 years.

ASSESSMENT OF RISK FACTORS

A retrospective chart review was conducted on patients evaluated from 2004 to 2012. Patients were selected by ICD-9 code for having a concussion during a sporting activity.

MAIN OUTCOME MEASURES

Discharge instructions were reviewed for recommendations for cognitive rest, physical rest, primary care physician follow-up, and referral to a concussion specialist or center.

RESULTS

There were 497 youth SRCs from 392 908 total ED visits. Overall, only 66% had appropriate discharge recommendations. This improved to 75% after 2010, which was not statistically significant (odds ratio = 1.02, P = 0.179). Only 4% of patients received a recommendation of cognitive rest, which only increased to 12% of the patients seen after 2010. Finally, referrals to a sports concussion specialist or center dramatically increased from an average of 8% to 43% after 2010.

CONCLUSIONS

Even with the CDC Heads-Up campaign on concussion education, there is still need to improve appropriateness of discharge instructions for youth SRCs. There have been dramatic increases in referrals to sports concussion specialists and centers after 2010.