Center for Injury Research and Prevention

Practice Patterns in Pharmacologic and Non-pharmacologic Therapies for Children with Mild Traumatic Brain Injury: A survey of 15 Canadian and United States Centers.

TitlePractice Patterns in Pharmacologic and Non-pharmacologic Therapies for Children with Mild Traumatic Brain Injury: A survey of 15 Canadian and United States Centers.
Publication TypeJournal Article
Year of Publication2019
AuthorsMannix R, Zemek R, Yeates KO, Arbogast KB, Atabaki S, Badawy M, Beauchamp MHelen, Beer D, Bin S, Burstein B, Craig W, Corwin D, Doan Q, Ellis M, Freedman S, Gagnon I, Gravel J, Leddy JJ, Lumba-Brown A, Master CL, Mayer A, Park G, Penque M, Rhine T, Russell K, Schneider K, Bell MJ, Wisniewski SR
JournalJ Neurotrauma
Date Published04/2019
ISSN1557-9042
Abstract

Given the lack of evidence regarding effective pharmacologic and non-pharmacologic interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI. The survey, developed by a panel of pediatric mTBI experts, consisted of a 10-item survey instrument regarding providers' perception of common pediatric mTBI symptoms and mTBI interventions. Surveys were distributed electronically to a convenience sample of local experts at each center. Frequencies and percentages (with confidence intervals) were determined for survey responses. One hundred and seven respondents (71% response rate) included specialists in pediatric Emergency Medicine, Sports Medicine, Neurology, Neurosurgery, Neuropsychology, Neuropsychiatry, Physical and Occupational Therapy, Physiatry/Rehabilitation and General Pediatrics. Respondents rated headache as the most prevalently reported symptom after pediatric mTBI, followed by cognitive problems, dizziness, and irritability. Of the 65 (61%; [95% CI: 51,70]) respondents able to prescribe medications, non-steroidal anti-inflammatory medications (55%; [95% CI:42,68]) and acetaminophen (59%; [95% CI:46,71]) were most commonly recommended. One in five respondents reported prescribing amitriptyline for headache management after pediatric mTBI, whereas topiramate (8%; [95% CI: 3,17]) was less commonly reported. For cognitive problems, methylphenidate (11%; [95% CI: 4,21]) was used more commonly than amantadine (2%; [95% CI:0,8]). The most common non-pharmacologic interventions were rest ("always" or "often" recommended by 83% [95% CI: 63,92] of the 107 respondents), exercise (59%; [95%CI: 49,69]), vestibular therapy (42% [95%CI:33,53]) and cervical spine exercises (29% [95%CI:21,39]). Self-reported utilization for common pediatric mTBI interventions varied widely across our Canadian and United States consortium. Future effectiveness studies for pediatric mTBI are urgently needed to advance the evidence-based care.

DOI10.1089/neu.2018.6290
Alternate JournalJ. Neurotrauma
PubMed ID31025612