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Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management

  • Master, Christina L.1, 2
  • Curry, Allison E.2, 3
  • Pfeiffer, Melissa R.2
  • Metzger, Kristina B.2
  • Kessler, Ronni S.2
  • Haarbauer-Krupa, Juliet4
  • DePadilla, Lara4
  • Greenspan, Arlene4
  • Breiding, Matthew J.4
  • Arbogast, Kristy B.2
  • 1 Sports Medicine and Performance Center, Children’s Hospital of Philadelphia
  • 2 Center for Injury Research and Prevention, Children’s Hospital of Philadelphia
  • 3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
  • 4 National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
Published Article
The Journal of pediatrics
Publication Date
Jun 04, 2020
DOI: 10.1016/j.jpeds.2020.04.001
PMID: 32507622
PMCID: PMC7419017
PubMed Central


Objective To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes. Study design A single-institution retrospective cohort study using electronic health record data from children ages 5- to 11 years with a concussion from July 1, 2014, through June 30, 2015. Electronic health record data were abstracted for a 20% random sample of 292 patients. Results Three-fourths of patients (74.3%) presenting for concussion care had a standardized visiovestibular assessment performed. Almost all of those who eventually sought specialty care (92.9%) also had such an assessment, and only 42.9% patients initially seen in the emergency department or urgent care were examined in this manner. Of those assessed, 62.7% (n = 136) demonstrated deficits, with children ages 9-11 years more frequently exhibiting deficits than their younger counterparts (67.9% vs 53.2%; P = .03). Almost all patients (95.9%) reported at least 1 somatic symptom (eg, headache, dizziness), and one-half to two-thirds reported problems with sleep (54.1%) and visiovestibular symptoms (66.1%). Only 11.6% of children were referred for rehabilitation therapies and less than one-half of concussed patients (43.8%) were provided with a letter recommending school accommodations. Conclusions Somatic symptoms, sleep problems, and visiovestibular deficits are common in elementary school-aged children with concussion, but specific visiovestibular clinical assessments are often not performed, particularly in the emergency department setting. Recommendations for school accommodations are often not provided at the time of concussion diagnosis. Incorporating a standardized visiovestibular assessment into practice could facilitate early targeted school accommodations and thereby improve return to learning for elementary school-aged children with concussion.

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