Follow-up visits after a concussion in the pediatric population: An integrative review

BACKGROUND: Concussions are a significant health issue for children and youth. After a concussion diagnosis, follow-up visits with a health care provider are important for reassessment, continued management, and further education. OBJECTIVE: This review aimed to synthesize and analyse the current state of the literature on follow-up visits of children with a concussive injury and examine the factors associated with follow-up visits. METHODS: An integrative review was conducted based on Whittemore and Knafl’s framework. Databases searched included PubMed, MEDLINE, CINAHL, PsycINFO, and Google Scholar. RESULTS: Twenty-four articles were reviewed. We identified follow-up visit rates, timing to a first follow-up visit, and factors associated with follow-up visits as common themes. Follow-up visit rates ranged widely, from 13.2 to 99.5%, but time to the first follow-up visit was only reported in eight studies. Three types of factors were associated with attending a follow-up visit: injury-related factors, individual factors, and health service factors. CONCLUSION: Concussed children and youth have varying rates of follow-up care after an initial concussion diagnosis, with little known about the timing of this visit. Diverse factors are associated with the first follow-up visit. Further research on follow-up visits after a concussion in this population is warranted.

[1]  Angela H. Ciccia,et al.  Factors that Influence Follow-Up Care for Families of Children with Acquired Brain Injury: A Scoping Review , 2022, Brain injury.

[2]  Scott Ramsay.  Follow-up care in children and young people diagnosed with concussion: a commentary , 2021, British Journal of Neuroscience Nursing.

[3]  R. Orr,et al.  Early injury evaluation following concussion is associated with improved recovery time in children and adolescents. , 2021, Journal of science and medicine in sport.

[4]  Kristy B Arbogast,et al.  Characteristics and Outcomes for Delayed Diagnosis of Concussion in Pediatric Patients Presenting to the Emergency Department. , 2020, The Journal of emergency medicine.

[5]  Melissa R. Pfeiffer,et al.  Telephone Triage in Pediatric Head Injury: Follow-up Patterns and Subsequent Diagnosis of Concussion , 2020, Clinical nursing research.

[6]  M. Bayley,et al.  Increasing Incidence of Concussion: True Epidemic or Better Recognition? , 2020, The Journal of head trauma rehabilitation.

[7]  R. Comstock,et al.  Postconcussion Academic Support in Children Who Attend a Primary Care Provider Follow-up Visit after Presenting to the Emergency Department. , 2019, The Journal of pediatrics.

[8]  J. Yang,et al.  Initial Emergency Department Visit and Follow‐Up Care for Concussions among Children with Medicaid , 2019, The Journal of pediatrics.

[9]  E. Benzel,et al.  Strengthening the Evidence Base: Recommendations for Future Research Identified Through the Development of CDC's Pediatric Mild TBI Guideline , 2019, The Journal of head trauma rehabilitation.

[10]  R. Comstock,et al.  Factors Influencing Primary Care Follow-Up After Pediatric Mild Traumatic Brain Injury , 2019, The Journal of head trauma rehabilitation.

[11]  Ruben G. L. Real,et al.  A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury , 2018, Front. Neurol..

[12]  Adam R Ferguson,et al.  Assessment of Follow-up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion , 2018, JAMA network open.

[13]  G. Macartney,et al.  Concussion Symptom Prevalence, Severity and Trajectory: Implications for Nursing Practice , 2018, Journal of pediatric nursing.

[14]  S. Mcfaull,et al.  At-a-glance - Traumatic brain injury management in Canada: changing patterns of care. , 2018, Health promotion and chronic disease prevention in Canada : research, policy and practice.

[15]  K. Barlow,et al.  Pediatric Traumatic Brain Injury and Concussion , 2018, Continuum.

[16]  A. Macpherson,et al.  Annual Trends in Follow‐Up Visits for Pediatric Concussion in Emergency Departments and Physicians’ Offices , 2018, The Journal of pediatrics.

[17]  A. Macpherson,et al.  Annual trends in follow-up visits for paediatricpediatric concussion in emergency departments and doctors’ offices in ontario, canada between 2003–2013 , 2017, British Journal of Sports Medicine.

[18]  Jin Peng,et al.  Follow-Up Care Adherence After Hospital Discharge in Children With Traumatic Brain Injury , 2017, The Journal of head trauma rehabilitation.

[19]  Allen K. Sills,et al.  Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 , 2017, British Journal of Sports Medicine.

[20]  M. Essig,et al.  Multidisciplinary Management of Pediatric Sports-Related Concussion , 2016, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[21]  F. Rivara,et al.  Sports- and Recreation-Related Concussions in US Youth , 2016, Pediatrics.

[22]  M. Vavilala,et al.  Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury , 2016, Pediatrics.

[23]  J. Seabrook,et al.  Patterns of Recovery Following Sport-Related Concussion in Children and Adolescents , 2016, Clinical pediatrics.

[24]  I. White,et al.  Follow-up issues in children with mild traumatic brain injuries. , 2016, Journal of neurosurgery. Pediatrics.

[25]  D. McArthur,et al.  Targeting the Epidemic , 2016, Journal of child neurology.

[26]  R. Comstock,et al.  Outpatient follow-up and return to school after emergency department evaluation among children with persistent post-concussion symptoms , 2015, Brain injury.

[27]  H. Levin,et al.  Diagnosis, prognosis, and clinical management of mild traumatic brain injury , 2015, The Lancet Neurology.

[28]  K. Rubin,et al.  Impact of Co-management at the Primary-Subspecialty Care Interface on Follow-up and Referral Patterns for Patients With Concussion , 2015, Clinical pediatrics.

[29]  J. Register-Mihalik,et al.  Characteristics of Pediatric and Adolescent Concussion Clinic Patients With Postconcussion Amnesia , 2014, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[30]  A. Trickey,et al.  Are pediatric concussion patients compliant with discharge instructions? , 2014, The journal of trauma and acute care surgery.

[31]  G. Gioia,et al.  Use of Modified Acute Concussion Evaluation Tools in the Emergency Department , 2014, Pediatrics.

[32]  H. Keenan,et al.  Healthcare Utilization in the First Year After Pediatric Traumatic Brain Injury in an Insured Population , 2013, The Journal of head trauma rehabilitation.

[33]  A. Falk.  A nurse-led paediatric head injury follow-up service. , 2013, Scandinavian journal of caring sciences.

[34]  R. Whittemore,et al.  The integrative review: updated methodology. , 2005, Journal of advanced nursing.

[35]  Gary A. Smith,et al.  Length of Recovery From Sports-Related Concussions in Pediatric Patients Treated at Concussion Clinics , 2018, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[36]  Tricia Z. King,et al.  Rehabilitation and school services following traumatic brain injury in young children. , 2018, NeuroRehabilitation.

[37]  D. Wendling-Keim,et al.  Ambulatory or inpatient management of mild TBI in children: a post-concussion analysis , 2016, Pediatric Surgery International.