title: "My child doesn't have a brain injury, he only has a concussion".
abstract: OBJECTIVE
  The term "concussion" is frequently used in clinical records to describe a traumatic head injury; however, there are no standard definitions of this term, particularly in how it is used with children. The goals of this study were to examine the clinical correlates of the concussion diagnosis and to identify the factors that lead to the use of this term in a regional pediatric center.
  
  
  METHODS
  Medical data were prospectively collected from 434 children with traumatic brain injury who were admitted to a Canadian children's hospital. A proportional hazards regression was used to examine the association of the concussion diagnosis and the times until discharge and school return. A classification-tree analysis modeled the clinical correlates of patients who received a concussion diagnosis.
  
  
  RESULTS
  The concussion label was significantly more likely to be applied to children with mild Glasgow Coma Scale scores of 13 to 15 (P = .03). The concussion label was strongly predictive of earlier hospital discharge (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-1.9; P = .003) and earlier return to school (OR: 2.4 [95% CI: 1.6-3.7]; P < .001). A diagnosis of a concussion was significantly more likely when the computed-tomography results were normal and the child had lost consciousness.
  
  
  CONCLUSIONS
  Children with mild traumatic brain injuries have an increased frequency of receiving the concussion label, although the label may also be applied to children with more-severe injuries. The concussion diagnosis is associated with important clinical outcomes. Its typical use in hospital settings likely refers to an impact-related mild brain injury, in the absence of indicators other than a loss of consciousness. Clinicians may use the concussion label because it is less alarming to parents than the term mild brain injury, with the intent of implying that the injury is transient with no significant long-term health consequences.
authors.affiliation: MSc, McMaster University, School of Rehabilitation Science, Institute of Applied Health Sciences, Room 433, 1400 Main St West, Hamilton, Ontario, Canada L8S 1C7. dematteo@mcmaster.ca
authors.forename: Carol A
authors.initials: CA
authors.lastname: Dematteo
authors.forename: Steven E
authors.initials: SE
authors.lastname: Hanna
authors.forename: William J
authors.initials: WJ
authors.lastname: Mahoney
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hollenberg
authors.forename: Louise A
authors.initials: LA
authors.lastname: Scott
authors.forename: Mary C
authors.initials: MC
authors.lastname: Law
authors.forename: Anne
authors.initials: A
authors.lastname: Newman
authors.forename: Chia-Yu A
authors.initials: CY
authors.lastname: Lin
authors.forename: Liqin
authors.initials: L
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000145:classification* / Q000175:diagnosis; D001930:Brain Injuries / Q000145:classification* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D010351:Patient Discharge; D009626:Terminology as Topic