Paediatric sport related concussion pilot study.

A study was undertaken to determine the degree to which paediatric neurosurgeons agreed on the optimum management of sport related concussion in children. A paradigm for management of concussion in children has not been defined, and the management of such patients largely relies on expert advice from neurosurgeons. This pilot study aimed to establish current consensus neurosurgical practice for management of children with sport related concussion. Methods For the purposes of this study, we defined sport related concussion as a head injury occurring during sport (or play) participation in children 5–15 years of age with an admission Glasgow coma score of 15 and a normal neurological examination. A standar-dised questionnaire was sent to 20 neuro-surgeons throughout Australia identified as having specific expertise in paediatric neuro-surgery. There were three parts to the questionnaire. The first related to the routine management of uncomplicated sport related concussion in children. The second involved the role of follow up neuroimaging, neuro-psychology, protective equipment recommendations , and return to school advice. The third examined the degree of importance placed on a number of clinical prognostic indicators by the neurosurgeons. Results Thirteen paediatric neurosurgeons responded to the study (65% response rate). Only three respondents said that they would routinely use skull radiographs and two would routinely use computed tomography scans in uncomplicated sport related concussion. The respondents varied in their methods of dealing with concussed patients, with some recommending hospital admission, some discharging the patient home with the parents, and others recommending a period of observation in the emergency department. There was a complete lack of consensus among the respondents about the need for follow up, and, if it was thought to be necessary, the length varied from one to six weeks. None of the respondents stated that they would routinely perform neuroima-ging or neuropsychological testing at follow up. The results were similar for return to school and return to sport time frames, with ranges of one to six weeks. Six of the 13 respondents would routinely advise the use of a helmet, and three of the 13 would recommend the use of a mouth guard after such injuries. There was no consensus on which of these symptoms or signs are of prognostic importance. Discussion In children aged 15 years and under, traumatic brain injury is a common cause of presentation to emergency departments and general practitioners. In the United States, it has been estimated that more …