Shireen Atabaki MD, MPH, an Emergency Medicine physician at Children’s National Health System and an associate professor of pediatrics and emergency at the George Washington University– along with colleagues – have initiated go-to guidelines to revolutionize early recognition and management of concussion in children in the emergency department (ED).
Children’s National and the University of Pittsburgh Medical Center have modified an Acute Concussion Evaluation for Emergency Department (ACE-ED) diagnostic tool that can assist physicians and families in managing and evaluating concussion, which has become a growing concern nationwide, especially in children’s sports.
The diagnostic tool, which is coordinated with the Centers for Disease Control and Prevention, can help parents, families, and physicians properly monitor concussion symptoms and improve management of incidents in children, Atabaki, and other clinicians report in the journal Pediatrics.
Other lead authors include Gerard Gioia PhD, division chief of Neuropsychology at Children’s National and associate professor of pediatrics, psychiatry and behavioral sciences, at The George Washington University School of Medicine.
“The history and physical examination is the cornerstone of the diagnosis of concussion,” Atabaki writes. The ACE-ED can be an effective evaluation tool used by emergency departments to screen and manage concussion.
In a discussion yesterday about concussion with the NPR show Tell Me More, Atabaki says she and her colleagues at Children’s National have been working for a decade to improve coordination and care of concussion in children. Traumatic brain injury (TBI) is an important public health concern in children, with 1.4 million patients with TBIs evaluated and discharged from EDs annually in the U.S. Of these, nearly half are children or young adults younger than 19.
Despite growing numbers of concussion incidents and TBI evaluations, the figures may represent “the tip of the iceberg,” Atabaki says. As many as five million patients incur TBIs that are often neither recognized nor treated. Prolonged symptoms of concussion can result in depression or anxiety, and can continue for months or years if unrecognized, Atabaki told NPR host Michel Martin.
While emergency departments around the country treat children with concussion symptoms, they often do not have concussion screening tools to avoid future problems, Atabaki says. Historically, few EDs used any form of concussion screening in the evaluation of pediatric head trauma, Atabaki adds.
“We hope the results of the study published in Pediatrics will change that by giving emergency physicians effective tools to screen and manage concussions,” Atabaki says.
Children who have had concussions while playing sports, she says, usually ask: “When can I get back into the game? When can I play next?”
The diagnostic and management tool is a way that parents can work with physicians to evaluate the impact of children’s concussions, and establish a timetable for their care, especially through a concussion “checklist,” Atabaki says.
“The key is for parents to follow the recommendation of their physicians until the patient is symptom free,” she says. By having a management plan, parents will be able to provide information about concussion episodes involving their children’s school nurses, teachers, and athletic trainers so they can be cognizant of the issues, aware of symptoms and evaluate the students’ class and activity schedules, she told NPR.
At Children’s National and other hospitals, physicians are adopting quality concussion screening programs involving a multidisciplinary team of physicians and nurses, and utilizing electronic medical records in a fast-paced emergency department environment, she says. Without proper protocols, emergency departments have ordered costly and ineffective computer tomography (CT) scans, Atabaki says.
Contact: Emily Hartman or Joe Cantlupe, 202-476-4500.