The diagnosis of concussion in a pediatric emergency department.
OBJECTIVE
To compare the proportion of children diagnosed with a concussion by pediatric emergency physicians vs the proportion who met criteria for this injury as recommended by Zurich Fourth International Conference on Concussion consensus statement and to determine clinical variables associated with a physician diagnosis of a concussion.


METHODS
This was a prospective, cross-sectional study conducted at a tertiary care pediatric emergency department. We enrolled children ages 5 through 17 who presented with a head injury and collected data on demographics, mechanism of injury, head injury-related symptoms/signs, physician diagnosis, and discharge advice.


RESULTS
We identified 495 children whose mean age was 10.1 years (SD 3.4 years); 308 (62.2%) were male. Emergency physicians diagnosed concussion in 200 (40.4%; 95% CI 36.1, 44.7) children, and 443 (89.5%; 95% CI 86.8, 92.2) met criteria for concussion in accordance with the Zurich consensus statement (P<.0001). Age≥10 years (OR 1.8), presentation≥1 day after injury (OR 2.4), injury from collision sports (OR 5.6), and symptoms of headache (OR 2.2) or amnesia (OR 3.4) were the variables significantly associated with an emergency physician's diagnosis of concussion.


CONCLUSIONS
Pediatric emergency physicians diagnosed concussion less often relative to international consensus-based guidelines and used a limited number of variables to make this diagnosis compared with current recommendations. Thus, pediatric emergency physicians may be missing cases of concussion and the corresponding opportunity to provide critical advice for cognitive and physical management.
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada. Electronic address: kathy.boutis@sickkids.ca.
Kathy
K
Boutis
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada.
Kirstin
K
Weerdenburg
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada.
Ellen
E
Koo
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada.
Suzan
S
Schneeweiss
Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Canada.
Roger
R
Zemek
D000059:Accidents; D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000592:standards; D011446:Prospective Studies