Parental Expectations for Concussion Care

January 10, 2017

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Short Attention Span Summary

Johnny bonked his head
What do parents expect when they bring little Johnny in for his concussion?  A lot, according to this study!  Given a web-based survey with the scenario of a 10 to 17 year old with mild concussion symptoms, 42% of parents would bring the child in right away.  Those parents were more likely to expect imaging.  Most parents also expected a definitive diagnosis of concussion, timeline to return to play, and signed return to play form.  My personal approach is to discuss the risk the patient has per the PECARN rule vs the risk of CT.  And I quantify the amount of CT radiation exposure in terms of CXR-equivalents.  This always gets parents’ attention.  Most think CT is similar to an x-ray.  I think it is reasonable to discuss pros/cons of imaging, to give a definitive diagnosis of concussion, to give a rough sketch of the time needed to recover, but I do not sign return to play forms.  Meeting reasonable expectations matters in an era in which patient satisfaction is tied to reimbursement.

Spoon Feed
Parental expectations for pediatric concussion care are high, but most of their expectations are reasonable.  However, I don’t sign return to play forms in the ED.  This needs to be done by the primary doctor or sports medicine clinician.  They can’t return to play until asymptomatic.  If they were asymptomatic, they wouldn’t have come into the ED.

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Abstract

J Pediatr. 2016 Nov 16. pii: S0022-3476(16)31205-7. doi: 10.1016/j.jpeds.2016.10.071. [Epub ahead of print]

Pediatric Concussion Management in the Emergency Department: A National Survey of Parents.

Zamarripa A1, Clark SJ2, Rogers AJ3, Wang-Flores H3, Stanley RM4.

Author information:

1Department of Emergency Medicine, Spectrum Health/Helen DeVos Children’s Hospital, Michigan State University, Grand Rapids, MI. Electronic address: acmzama@gmail.com.

2Department of Pediatric, University of Michigan, Ann Arbor, MI; Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI.

3Department of Pediatric, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.

4Nationwide Children’s Hospital, Ohio State University, Columbus, OH.

Abstract

OBJECTIVE:

To examine parental expectations and beliefs about diagnosis and management of pediatric concussion.

STUDY DESIGN:

We conducted a cross-sectional web-based survey of a nationally representative panel of US parents in March 2014. Parents of 10- to 17-year-old children responded to questions about their expectations and beliefs about diagnosis and management of pediatric concussion in the emergency department (ED). Weighted percentages for descriptive statistics were calculated, and χ2 statistics were used for bivariate analysis.

RESULTS:

Survey participation was 53%, and of 912 parent respondents with a child 10-17 years of age who were presented with a scenario of their child having mild symptoms of concussion, 42% would seek immediate ED care. Parents who would seek immediate ED care for this scenario were more likely than parents who would consult their child’s usual provider or wait at home to “definitely expect” imaging (65% vs 21%), definitive diagnosis of concussion (77% vs 61%), a timeline for return to activity (80% vs 60%), and a signed return to play form (55% vs 41%).

CONCLUSIONS:

Many parents who bring children to the ED following a possible concussion are likely to expect comprehensive and definitive care, including imaging, a definitive diagnosis, a timeline for return to activity, and a signed return to play form. To manage these expectations, healthcare providers should continue to educate parents about the evaluation and management of concussion.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27863850 [PubMed – as supplied by publisher]