E. Lindholm1, R. D’Cruz3, R. Fajardo2, T. Meckmongkol1, S. Ciullo1, H. Grewal1, R. Prasad1, L. G. Arthur1 1St. Christopher’s Hospital For Children,Division Of Pedatric General, Thoracic & Minimally Invasive Surgery,Philadelphia, PA, USA 2Temple University,Department Of General Surgery,Philadelphia, PA, USA 3Albert Einstein College Of Medicine,Department Of General Surgery,Philadelphia, PA, USA
Introduction: There is no consensus on the management of patients with concussion and negative computed tomography (CT). Current protocol at our institution involves admitting any patient with symptoms worrisome for failure of outpatient management. We hypothesize that pediatric patients presenting to the emergency room with signs of concussion and a negative CT scan do not require routine hospital admission.
Methods: A retrospective chart review was conducted for pediatric trauma patients admitted to the hospital for concussion from 2010-2017. Only patients with negative head CT were included. All patients with additional injuries that would otherwise require hospital admission were excluded. Demographics, emergency room evaluation and hospital courses were reviewed.
Results: A total of 90 patients were identified (average age 10 years, (3 months-19 years); 72.2% male). Mechanism of injury included fall (34), sports injury (14), auto-pedestrian (14), MVC (13), assault (9), and auto-bike (3). The average GCS was 14.6 (range 9-15). LOC was reported by 35.5% (32) of patients. Reported symptoms included nausea/emesis in 35.5% and altered mental status in 40%. Additional imaging included cervical spine CT (36.6%), cervical spine radiograph (28.8%) and abdominal CT (11%). Additional injuries included fractures in 6 patients. Only 5 patients (5.5%) required hospitalization for longer than 24 hours, with an average stay of 3 days (range 2-4). Longer stay was required for DHS clearance (1), fever (1) and ability to tolerate diet (3). 47% of all patients were referred to a concussion specialist for follow-up after discharge, of these only 17% (8) came to their clinic appointment.
Conclusion: There are a large number of pediatric patients evaluated in the emergency room for concussion injuries. Very few of these patients require hospital admission regardless of symptoms such as loss of consciousness, nausea/emesis, or altered mental status. These hospitalizations are frequent in a Level 1, urban trauma center and thus, it would be cost effective to limit admission.