Research In Action

Concussion is a common injury evaluated in my pediatric emergency department (ED) practice setting. Some incredibly exciting advances in the past decade for concussion management in the specialty setting include research (including trials within our own Minds Matter Concussion program) showing the benefit of protocols for aerobic exercise rehabilitation and visio-vestibular therapy.

These targeted rehabilitation strategies have helped revolutionize the protocols of concussion management in the specialty care world, shifting from a passive approach to an active one. However, prescribing such protocols from the ED setting is rare, as we do not have the resources to track children adhering to such protocols, nor does every concussed youth diagnosed in the ED need such advanced protocols.

Therefore, determining an effective targeted specialty referral strategy for patients at high risk of developing prolonged symptoms from a concussion is critical to advancing our treatment of ED concussion patients. As a first step in this line of work, I collaborated with colleagues from the Medical College of Wisconsin, Children’s National Medical Center, and Hasbro Children’s Hospital (including CIRP Associate Fellow Mark Zonfrillo, MD, MSCE) to survey pediatric emergency medicine providers and assess their current practice patterns related to subspecialty referral of concussion patients.

In total, we surveyed 162 members of the American Academic of Pediatrics Section on Emergency Medicine Listserv, with some very interesting results:

• The majority reported both extensive experience (63.0%) and high confidence (54.9%) in managing pediatric concussion.
• Most providers refer to concussion specialists, but less than 1 in 5 do so >60% of the time.
• Almost 2/3 considered concussion specialty referral from the ED to be important.
• Almost 1/4 reported experiencing barriers to referral to concussion specialists, including insurance, appointment availability, and timing.
• A large majority (82.7%) would be likely to use an accurate risk stratification tool from the ED, but only a very small percentage (6.8%) reported frequently using a standardized risk stratification tool at this time.

Putting our results together, most pediatric ED providers feel that specialty referral plays an important role in the management of concussion patients from the ED setting, and even though few currently use risk stratification tools, there is a stated desire for the utilization of accurate risk stratification tools to inform referral. This work will directly allow us to begin evaluating the effectiveness of targeted specialty referral as a treatment strategy for concussed youth, to ultimately help improve outcomes for pediatric patients presenting to EDs for concussion.