324 - PEM Physicians’ Perspectives of Concussion in Young Children

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 324
Publication Number: 324.208

Julia Gombar, Weill Cornell Medicine, New York, NY, United States; Taylor A. Lis, Weill Cornell Medicine, New York, NY, United States; Wendy Yan, Weill Cornell Medicine, Brooklyn, NY, United States; Deborah A. Levine, Weill Cornell Medical College - New York, NY, Port Washington, NY, United States

Presenting Author(s)

JG

Julia Gombar, MD (she/her/hers)

Resident Physician
Weill Cornell Medicine
New York, New York, United States

Background: Traumatic brain injury (TBI) in children accounts for millions of emergency visits per year in the U.S. with the highest rates of ED visits in children under 4 years. Approximately one-third of children with TBI will develop post-concussive symptoms which can affect their learning and development. Despite the data, many physicians equate the term, “concussion,” with school age and/or sports injuries.

Objective: To explore pediatric emergency medicine (PEM) physician’s perspectives on “concussion” terminology, diagnosis, and management, specifically in a young child with mild TBI.

Design/Methods: We interviewed PEM physicians with a semi-structured interview guide with a hypothetical scenario. We recruited with snowball sampling. Interviews were recorded, transcribed, and analyzed by a research team (PEM physician, pediatric resident, medical student, and college and high school students). Using a phenomenological approach, we developed and refined codes inductively and derived themes until reaching thematic saturation. Peer debriefing with expert collaborators aided revision of themes.

Results:

Thirteen participants were interviewed via telephone by a single researcher. Participants from 5 U.S. states and 9 unique hospitals were enrolled. Fifty-four percent were female. Three primary themes emerged: 1) Use of clinical prediction rule for neuroimaging in young children. 2) Diagnosis and definition of concussion is largely based on symptomatology that varies with age. 3) Hesitancy to prescribe activity restriction after discharge due to young age. Table 1 provides specific examples for each theme.

Conclusion(s):

Variability exists among PEM physicians in diagnosis and management of concussions in young children. Lack of reliability of symptoms and underappreciation of activities of young children may account for findings. Age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with TBI.