York U study: Two-thirds of children with concussions not receiving medical followups

In a study that looked at data over a 10-year period, York University researchers, in collaboration with the Children’s Hospital of Eastern Ontario (CHEO) and the Institute for Clinical Evaluative Sciences (ICES), found that more than two-thirds of youth and children with an acute concussion do not seek medical followup or clearance as recommended by current international concussion guidelines.

In one of the first studies in Canada to look at pediatric concussion and followup, Professor Alison Macpherson in the Faculty of Health, School of Kinesiology & Health Science at York University, and former York University PhD student Liraz Fridman conducted research that included data from over 120,000 children five to 19 years of age. The goal of the study was to determine whether children and youth with concussion receive followup visits in accordance with the recommended guidelines.

The team looked at population-based administrative data housed at ICES from all concussion-related visits to emergency departments and physician offices in Ontario from 2003 to 2013.

Researchers analyzed the percentage of children and youth seen for followup. Over the decade of study, the data showed that there was an increase in the number of children who sought followup care after being evaluated for a concussion by 2013, but more than two-thirds still did not receive followup care in accordance with international recommended guidelines.

“That two-thirds of children were still not being seen for followup was surprising considering that international recommendations have been in place since 2001,” said Fridman.

In Ontario, concussion-related emergency department and office visit rates per 100,000 children have quadrupled from 2003-13, with similar increases noted in the United States. Concussions can have long-term effects on memory and cognition, and may increase the vulnerability of psychological implications, such as depression and anxiety.

In 2003, 11 per cent of children and youth were seen for a followup after sustaining a concussion. By 2013, that number jumped to 30 per cent.

“A lack of sufficient followup care puts children and youth at risk for another concussion or more serious consequences,” said Macpherson.

Researchers say it is unclear why those who have concussions do not receive adequate followup and treatment. However, the study highlights the need for better education programs for health-care professionals, parents, coaches, children and youth, which may improve followup rates.

“Despite improvement over the past several years, the rate of followup visits after a pediatric concussion diagnosis remain unacceptably low,” said Roger Zemek, director of Clinical Research at the Children’s Hospital of Eastern Ontario and a senior author. “This reinforces the ongoing need to ensure that the latest concussion guidelines are implemented broadly in order to standardize the approach to concussion diagnosis and management.”

Currently the Rowan’s law committee is looking at concussion legislation in Ontario, which will likely increase the number of children and youth who receive followup care. The study is published in the Journal of Pediatrics.

Watch York U researchers explain the findings in this video: