Engel Jake, van Ierssel Jacqueline Josee, Osmond Martin H, Tsampalieros Anne, Webster Richard, Zemek Roger
University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (Mr Engel and Drs Osmond and Zemek); Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada (Drs van Ierssel, Osmond, Tsampalieros, Webster, and Zemek); and Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada (Drs Osmond and Zemek).
J Head Trauma Rehabil. 2023;38(4):319-328. doi: 10.1097/HTR.0000000000000852. Epub 2023 Feb 28.
To determine the proportion of concussed children returning to the emergency department (ED) for a concussion-related reason within 3 months of initial presentation and to determine which clinical composite score (5P or Post-Concussion Symptom Inventory) best predicts a return visit.
SETTING, DESIGN, AND PARTICIPANTS: We combined a secondary analysis of data from the prospectively collected 5P study with a retrospective medical record review of children aged 5 to 18 years who returned to the Children's Hospital of Eastern Ontario (CHEO) ED for a concussion-related reason within 3 months of an acutely diagnosed concussion. Among 770 eligible participants, 632 children (median age: 11.8 [interquartile range (IQR), 9.0-14.5] years; 58.9% male) were included in the study.
The primary outcome was the number of patients who returned to CHEO ED for a concussion-related reason within 3 months of an acute concussion diagnosed at CHEO ED. The secondary outcome was number of patients who returned within 14 days.
Forty-seven children (7.4%; 95% confidence interval [CI]: 5.6-9.7) had a concussion-related return to the ED within 3 months, the majority of which occurred in the first 14 days (29/47; 61.7%; 95% CI: 47.4-74.2). History of migraines (21.3% vs 9.7%; P = .03) were more common in those with a return visit. Headache was the most frequently reported symptom (87.2%) on revisit. Females aged 13 to 18 years had the highest return rate (survival rate: 85.8% [95% CI: 79.8-92.3]) compared with males and younger age groups. In multivariable Cox hazards regression modeling, inclusion of risk scores improved prognostication (pseudo R2 = 8%). The difference in pseudo R2 between 5P and Post-Concussion Symptom Inventory is small.
Most children and adolescents do not return to the ED following an acute concussion. Female youth with medium to high 5P scores at the index concussion visit may benefit from early referral to interdisciplinary specialty concussion care to guide treatment in anticipation of prolonged symptoms. By identifying these risk factors at the initial ED visit, healthcare and patient burden may be reduced.
确定初次就诊后3个月内因与脑震荡相关的原因返回急诊科（ED）的脑震荡儿童比例，并确定哪种临床综合评分（5P或脑震荡后症状量表）最能预测复诊情况。
设置、设计与参与者：我们将前瞻性收集的5P研究数据的二次分析与对5至18岁儿童的回顾性病历审查相结合，这些儿童在急性诊断为脑震荡后的3个月内因与脑震荡相关的原因返回安大略东部儿童医院（CHEO）急诊科。在770名符合条件的参与者中，632名儿童（中位年龄：11.8岁[四分位间距（IQR），9.0 - 14.5岁]；58.9%为男性）被纳入研究。
主要结局是在CHEO急诊科急性诊断为脑震荡后3个月内，因与脑震荡相关的原因返回CHEO急诊科的患者数量。次要结局是在14天内返回的患者数量。
47名儿童（7.4%；95%置信区间[CI]：5.6 - 9.7）在3个月内因与脑震荡相关的原因返回急诊科，其中大多数发生在最初的14天内（29/47；61.7%；95%CI：47.4 - 74.2）。偏头痛病史在复诊患者中更常见（21.3%对9.7%；P = 0.03）。头痛是复诊时最常报告的症状（87.2%）。13至18岁的女性复诊率最高（生存率：85.8%[95%CI：79.8 - 92.3]），高于男性和较年轻年龄组。在多变量Cox风险回归模型中，纳入风险评分可改善预后（伪R² = 8%）。5P和脑震荡后症状量表之间的伪R²差异很小。
大多数儿童和青少年在急性脑震荡后不会返回急诊科。在初次脑震荡就诊时5P评分中等到高的女性青少年可能会从早期转诊至多学科专业脑震荡护理中受益，以指导针对预期的长期症状的治疗。通过在初次急诊科就诊时识别这些风险因素，可减轻医疗保健和患者负担。
