Use of modified acute concussion evaluation tools in the emergency department. Pediatrics 2014 Apr;133(4):635-42
Date
03/13/2014Pubmed ID
24616361DOI
10.1542/peds.2013-2600Scopus ID
2-s2.0-84898763838 (requires institutional sign-in at Scopus site) 68 CitationsAbstract
OBJECTIVES: Accurate recognition of pediatric concussion in the emergency department (ED) is important to ensure appropriate management for safe recovery. The study objective was to determine whether the Centers for Disease Control and Prevention's Acute Concussion Evaluation (ACE) tools, modified for ED use, improved patient follow-up and post-injury behaviors.
METHODS: The original ACE tools (ACE, ACE Care Plan) were modified for ED use via Delphi methodology with an expert panel and implemented in 2 urban pediatric EDs for patients aged 5 to 21 years evaluated within 24 hours of a head injury. Pre- (February 2009 to July 2009) and post- (December 2009 to June 2010) implementation, patient phone surveys were conducted 1, 2, and 4 weeks after ED discharge. Reported rates of patient follow-up and recovery measures were analyzed. ED clinician adherence was assessed.
RESULTS: During the study, 164 patients were enrolled pre-implementation and 190 post-implementation. The mean patient age was 10.6 years (SD, 3.7); 65% were males, 49% were African American, and 46% were Caucasian. Post-implementation, 58% of patients received the modified ACE diagnostic tool and 84% received the modified ACE discharge instructions. Follow-up was improved at all time points (32% vs 61% at week 4; P < .001; odds ratio, 3.4; 95% confidence interval, 2.1-5.4). Post-implementation, parental recall of discharge instructions was significantly increased, patient's mean total post-concussion symptom score was significantly higher, and report of return to normal activity was significantly longer.
CONCLUSIONS: The ACE tools, modified for ED use, were successfully implemented in the pediatric ED. Post-implementation, increased patient follow-up and improved recall of and adherence to ED discharge recommendations was demonstrated.
Author List
Zuckerbraun NS, Atabaki S, Collins MW, Thomas D, Gioia GAAuthor
Danny G. Thomas MD, MPH Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute DiseaseBrain Concussion
Child
Diagnostic Techniques, Neurological
Emergency Service, Hospital
Female
Humans
Male
Patient Discharge
