Loading...
Prior studies have shown that adolescent athletes with concussions often do not follow guidelines governing when they can return to play. To further examine this issue, investigators conducted a prospective cohort study of 150 pediatric patients (median age, 13 years) diagnosed with concussion during a 1-year period at a single pediatric emergency department (ED).
At discharge, patients received instructions developed from the third international Consensus Statement on Concussion in Sport. Follow-up phone surveys assessing nonadherence — returning to play or normal activities on or before resolution of symptoms or without medical clearance — were completed by 83% of patients at 2 weeks and by 77% at 4 weeks.
Results were as follows:
39% reported returning to play on the same day as the injury.
Of the 44% who returned to activities at 2 weeks, 58% had not received medical clearance and 35% were still symptomatic.
Of the 64% who returned to activities at 4 weeks, 46% had not received medical clearance and 23% were symptomatic.
Patients with sports concussions were more likely than those with non-sports concussions to have received medical clearance before returning to play at 2 weeks (54% vs. 20%), but not at 4 weeks.
Returning to play with symptoms and without medical clearance was not associated with age.
Hwang V et al. Are pediatric concussion patients compliant with discharge instructions? J Trauma Acute Care Surg 2014 Jul; 77:117. (http://dx.doi.org/10.1097/TA.0000000000000275)
Comment
Despite a national campaign to improve long-term outcomes from pediatric concussions, adherence to discharge instructions is dismal. ED providers can be a strong voice in educating parents and, at discharge, should stress the importance of compliance with guidelines.