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Multidisciplinary Management of Pediatric Sports-Related Concussion

  • Michael J. Ellis (a1) (a2) (a3) (a4) (a5) (a6), Lesley J. Ritchie (a7) (a4) (a6), Patrick J. McDonald (a1) (a2) (a3) (a4) (a5) (a6), Dean Cordingley (a4) (a6), Karen Reimer (a8) (a4) (a6), Satnam Nijjar (a9) (a4) (a6), Mark Koltek (a10) (a4) (a6), Shahid Hosain (a10) (a4) (a6), Janine Johnston (a9) (a4) (a6), Behzad Mansouri (a9) (a4) (a6), Scott Sawyer (a2) (a4) (a6), Norm Silver (a2) (a4) (a6), Richard Girardin (a4) (a6), Shannon Larkins (a8) (a4) (a6), Sara Vis (a4) (a6), Erin Selci (a2) (a6), Michael Davidson (a11) (a4) (a6), Scott Gregoire (a11) (a4) (a6), Angela Sam (a11) (a4) (a6), Brian Black (a1) (a2) (a12) (a4) (a6), Martin Bunge (a2) (a11) (a4) (a6), Marco Essig (a11) (a4) (a6), Peter MacDonald (a12) (a4) (a6), Jeff Leiter (a1) (a4) (a6) and Kelly Russell (a2) (a8) (a5) (a6)...

Abstract

Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

Prise en charge par une équipe multidisciplinaire de la commotion cérébrale subie au cours d’activités sportives chez des enfants. Objectifs: Le but de l’étude était de résumer les caractéristiques cliniques et les résultats du traitement chez des enfants qui ont subi une commotion cérébrale au cours d’activités sportives (CCS) et qui ont été évalués et traités dans le cadre d’un programme pédiatrique multidisciplinaire de traitement de la commotion cérébrale. Le but était également d’examiner les ressources sanitaires et le personnel requis pour satisfaire aux besoins de cette population de patients. Méthodologie: Nous avons effectué une revue rétrospective des dossiers de tous les patients pédiatriques ayant subi une CCS qui ont été référés au Pan Am Concussion Program du 1er septembre 2013 au 25 mai 2015. Le même neurochirurgien a procédé aux évaluations initiales et a posé les diagnostics. Une équipe multidisciplinaire décidait du moment du retour au jeu. Résultats: Six cent quatre patients, dont 423 patients pédiatriques ont été évalués par le Pan Am Concussion Program au cours de cette période. L’âge moyen des patients de l’étude était de 14,30 ans (écart type : 2,32 ; intervalle 7 à 19 ans) et 252 (59,57%) étaient de sexe masculin. Au moment de la blessure, les sports les plus fréquemment pratiqués étaient le hockey (182 ; 43,03%) et le soccer (60 ; 14,18%). En tout, 294 (69,50%) patients atteints d’une CCS rencontraient les critères cliniques de rétablissement suite à la commotion cérébrale alors que 75 (17,73%) ne se sont pas présenté pour le suivi et 53 (12,53%) étaient encore sous traitement à la fin de la période de l’étude. La durée médiane des symptômes chez les 261 patients ayant subi une CCS et dont le suivi était complet était de 23 jours (écart interquartile : 15 à 36). En tout, 25,30% des patients pédiatriques atteints d’une CCS ont subi au moins un test d’imagerie diagnostique et 32,62% ont été référés à un autre membre de notre équipe clinique multidisciplinaire. Conclusion: Pour recevoir des soins complets, les patients pédiatriques présentant une CCS doivent avoir accès à des ressources diagnostiques appropriées et à la collaboration multidisciplinaire d’experts ayant une formation reconnue au niveau national et provincial sur le traumatisme crânien.

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Copyright

Corresponding author

Correspondence to: Michael Ellis, Pan Am Clinic, 75 Poseidon Bay, Winnipeg, MB,Canada R3M 3E4. Email: mellis@panamclinic.com.

References

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