Injury patterns of concussion/mild traumatic brain injury in children presenting to a major Australian paediatic trauma centre

Abstract

Background: Children commonly present to emergency departments for concussion/mild traumatic brain injury(mTBI), yet little is known of this pattern of paediatric injury. The aim of the study was to estimate the incidence, demographics and injury pattern of concussion/mTBI in children coming to a major Australian paediatic trauma centre for emergency care. Methods: This is a single centre retrospective study of children 0-16 years old, with a diagnosis of concussion/mTBI presenting for emergency care over a 6-year period (Jan 2014-Jan 2020). The patient electronic Medical Records (eMR) were accessed using the diagnostic codes S0.09+; these codes being for head and neck injury. Data was retrieved on 37,000 emergency department visits, with only those visits fulfilling criteria for concussion/mTBI being eligible for comprehensive review of the eMR. Simple descriptive statistics were used. Results: Of the 37,000 paediatric visits in the 6-year sample, there were 10,530 concussion/mTBI giving an approximate rate of 1,755 visits annually for concussion/mTBI; 39% being sports-related. The mean age of patients was 12.9 years, with males accounting for 69% of patients and 39% sports-related injuries. Of this total cohort, 28% were discharged without specific instructions to follow-up with an out-patient provider for further management. Three main injury patterns were revealed upon further review. In 70.8% of cases, the injury was a single isolated injury, with rapid symptom recovery and a mean hospital stay of 6.6 hours, and in 1% a parent or caregiver insisted upon imaging. The remaining 29.2% of cases were complex injuries. Of these, approximately one-third of patients were predominantly male and clinically important, having either altered mental state, significant amnesia, symptom spiking and/or a seizure. Almost all cases were imaged and hospitalised with a mean stay of 28.8 hour and needed specialist follow-up. The remaining two-thirds of patients with complex injury had a complicated recovery course marked by high symptom burden with possible co-morbidity; 18.9% were imaged. Almost all cases were hospitalised with a mean stay of 26.5 hours and given specialist follow-up. Discussion: In our institution, approximately 1,800 paediatric patients present with a concussion/mTBI each year for emergency care. Simple injuries are rapidly assessed with little burden placed on the system, while complex injuries place a significant burden on the health system with most needing specialty follow-up care. This construct is being used to form the framework of a common concussion/mTBI pathway for use in paediatric emergency care and enable planning for essential health services. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.