title: Outpatient follow-up and return to school after emergency department evaluation among children with persistent post-concussion symptoms.
abstract: OBJECTIVE
  To describe differences in outpatient follow-up and academic accommodations received by children with and without persistent post-concussion symptoms (PPCS) after emergency department (ED) evaluation. It was hypothesized that children with PPCS would have more outpatient visits and receive academic accommodations more often than children without PPCS and that follow-up would be positively associated with receiving accommodations.
  
  
  METHODS
  Children aged 8-18 years with acute (≤6hours) concussion at time of presentation to a paediatric ED were enrolled in an observational study. Outcomes were assessed through a telephone survey 30 days after injury.
  
  
  RESULTS
  Of 234 enrolled participants, 179 (76%) completed follow-up. PPCS occurred in 21%. Only 45% of subjects had follow-up visits after ED discharge. Follow-up visit rates were similar for those with and without PPCS (58% vs. 41%, respectively; p = 0.07). Children with PPCS missed twice as many school days as those without (3 vs. 1.5; p < 0.001), but did not differ in receiving academic accommodations (36% vs. 53%; p = 0.082). Outpatient follow-up was associated with receiving academic accommodations (RR = 2.2; 95% CI = 1.4-3.5).
  
  
  CONCLUSIONS
  Outpatient follow-up is not routine for concussed children. Despite missing more school days, children with PPCS do not receive academic accommodations more often. Outpatient follow-up may facilitate academic accommodations.
authors.affiliation: a Department of Pediatrics, University of Colorado , Boulder , CO , USA.|b Emergency Department and.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Grubenhoff
authors.affiliation: c Department of Research Informatics, Children's Hospital Colorado , Aurora , CO , USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Deakyne
authors.affiliation: a Department of Pediatrics, University of Colorado , Boulder , CO , USA.|d Colorado School of Public Health , Aurora , CO , USA.
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
authors.affiliation: e Department of Physical Medicine and Rehabilitation, University of Colorado , Boulder , CO , USA , and.|f Rehabilitation Medicine, Children's Hospital Colorado , Aurora , CO , USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kirkwood
authors.affiliation: a Department of Pediatrics, University of Colorado , Boulder , CO , USA.|b Emergency Department and.
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
keywords: Acute brain injury; brain concussion; emergency medicine; post-concussion symptoms; post-concussion syndrome; traumatic brain injury