Concussions do not come with easy answers. That lesson was recently reinforced with a study from The Children’s Hospital of Philadelphia that sought to use a simple test to triage patients in the emergency department to determine which ones might need more complex follow-up care. All of the children performed poorly on the test. CHOP experts argue that it is important for all children with mild head injuries to receive structured care, typically from their primary care pediatrician.
As they reported in the journal Brain Injury earlier this year, they evaluated the use of a widely used and validated neurocognitive test, a computer program called Immediate Post-concussion Assessment and Cognitive Testing (ImPACT©), to measure performance of youth with blunt trauma head injuries while they are in the ED. The test had potential to be a practical choice because many schools require that student athletes take this test to get personal baseline measurements while they are healthy.
Ultimately, though, the study team concluded that the test will not become useful as a triage tool in the ED. (This month, a Canadian team published a larger study in the Journal of the American Medical Association, showing only modest success using a more complex predictive scoring measure for the same purpose. They also did not yet recommend clinical use of the predictive scoring tool.)
“The bottom line is that we found all the kids with concussions demonstrated significant abnormalities,” said Michael Nance, MD, director of the pediatric trauma program at CHOP. “You probably can’t predict who will have what outcome that early. With the pervasiveness of symptoms in the ED population, our findings strongly argue for structured follow-up after discharge from the emergency department.”
In CHOP’s clinical care practices, families are encouraged to bring children with suspected concussion to their primary care doctors, who have received comprehensive concussion-related training and who are part of a network-wide, streamlined process for follow-up care.
See the full version of this article in the March issue of Bench to Bedside.