Most children with concussion go to family doctor but missed from counts

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About one-third of concussion patients were younger than 12 in a U.S. study but surveillance often focuses on high school students. (Adam Berry/Getty)

The number of childhood concussions is vastly underestimated when only emergency department visits are counted say researchers who expanded the scope of their count to family doctor’s offices.

Family doctors can evaluate the brain injury because specialized equipment isn’t needed, researchers in Philadelphia said.

They checked electronic health records for about 8,000 patients aged 17 and under who sought treatment for concussions over four years. Traditionally researchers just counted emergency department visits for concussions.

Nearly 82 per cent headed to primary care offices. The study’s authors called it appropriate to do so unless there are severe symptoms such as seizures or blurred vision.

The main symptoms of concussion include:

  • Headache.
  • Blurred vision.
  • Nausea.
  • Dizziness.

A child may also be more confused or show changes in memory.

About one-third of the concussion patients were younger than 12, the investigators said in this week’s issue of the journal JAMA Pediatrics. They’re an important part of the concussion population who are missed by surveillance focused on high school students, said Kirsty Arbogast, the study’s lead author at the Children’s Hospital of Philadelphia.

The study’s findings are important, said Alison Macpherson, a professor in the school of kinesiology and health science at Toronto’s York University. Macpherson has looked at pediatric concussion visits in Ontario.

“If you suspect your child has a concussion, they can be seen by your family doctor,” Macpherson suggested.

While family doctors a resource, there’s still a need for ongoing education around concussion by family and emergency physicians, she said.

More younger kids go to emergency

“Only targeting ED physicians for education around concussions will miss an important audience,” Macpherson added in an email.

In the study, the proportion of patients who headed to a primary care office increased 13 per cent from 2010 to 2014. During the same time period emergency visits decreased 16 per cent.

Children younger than five were more likely than older kids to go to emergency. Since concussion is challenging to diagnose in infants and toddlers who often can’t reliably express their symptoms, it could be parents were more likely to see emergency care for an urgent evaluation, the study’s authors said.

They also acknowledged an important group was missed: those who didn’t seek care for concussion, either because they didn’t recognize it, a child didn’t want to disclose their symptoms or the family didn’t perceive the need for medical care. The authors called this missed group a “significant societal issue in need of further study.”

The study was funded by the U.S. Department of Health and human Services, Centers for Disease Control and Prevention and Children’s Hospital of Philadelphia.

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Most children with concussion go to family doctor but missed from counts

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